MRI bone oedema predicts eight year tendon function at the wrist but not the requirement for orthopaedic surgery in rheumatoid arthritis

Abstract

Objective: To investigate the role of early magnetic resonance imaging (MRI) of the wrist in predicting functional outcome in rheumatoid arthritis. Methods: MRI scans of the dominant wrist were scored for synovitis, tendon inflammation, bone oedema, and erosion at first presentation (n = 42), at 1 year (n = 42), and at 6 years (n = 31). At 8 years, clinical reassessment (n = 28) was undertaken. Tendon function was graded 0-3 for movement, tendon sheath swelling, and pain on resistance at nine flexor and extensor tendons of the hand. Hand function was also assessed using the Sollerman grip test. The requirement for joint or tendon surgery by 8 years was determined by telephone survey in 39 of the original 42 patients. Results: At 8 years, tendon function was highly correlated with hand function (Sollerman score, R = 20.51, p = 0.005) and global function (health assessment questionnaire score, R = 0.53, p = 0.004). Using a model incorporating baseline and 1 year MRI scores, the MRI bone oedema score was strongly predictive of tendon function at 8 years (x 2 2 = 15.3, p = 0.0005), as was the MRI bone erosion score (x 2 2 = 9.23, p = 0.01). Hand function was also predicted by the baseline MRI erosion score (p = 0.02). MRI variables did not predict the requirement for surgery, but patients who had surgery were more likely to show progression of MRI bone erosion scores between baseline and 1 year (p = 0.008). Conclusions: Extensive MRI bone oedema and erosions at the wrist in early rheumatoid arthritis predict tendon dysfunction and impaired hand function in the medium term but not the requirement for joint or tendon surgery.

Rapid reduction in tenosynovitis of the wrist and fingers evaluated by MRI in patients with rheumatoid arthritis after treatment with etanercept

“…Reduction in synovitis or bone oedema correlates with a reduction in HAQ 7 31. Tenosynovitis correlates with functional capacity and especially hand functional capacity in the long term 1 24. The lack of correlation between a reduction in tenosynovitis and HAQ in our study could be related to the short time of treatment, persistence of synovitis and to the fact that HAQ is a global measure of functional capacity.…”

“…MRI has been shown to be more sensitive than physical examination in the evaluation of tendinous disorders of hands and feet in patients with RA 23. Moreover, extensive and early tendon involvement in RA correlates with a worse functional capacity outcome since it is a predictor for functional capacity of the hand and tendon ruptures in the long term 1 24. Evaluation of tenosynovitis and early treatment could therefore avoid invasive treatments such as prophylactic tenosynovectomy which was used in the last decade 25–27…”

“…Tenosynovitis is an inflammatory process of the synovial tendon sheath that may result in degeneration and rupture of the tendons and may contribute to bone erosions, development of joint deformities and loss of functional capacity 1. Clinical evaluation of tenosynovitis is difficult and conventional radiography is not useful.…”

The impact of MRI on the clinical management of inflammatory arthritides

“…Data from the same cohort revealed that extensive MRI BME and erosions at the wrist in early rheumatoid arthritis predicted tendon dysfunction and impaired hand function [137]. Furthermore, a high baseline MRI tendinopathy score was predictive of tendon rupture at 6 years (odds ratio 1.52) [138].…”

Ultrasonography and magnetic resonance imaging in early rheumatoid arthritis: Recent advances

“…Recently, data from the same cohort revealed that extensive MRI bone edema and erosions at the wrist in early RA predicted tendon dysfunction and impaired hand function [69]. Furthermore, a high baseline MRI tendinopathy score was predictive of tendon rupture at 6 years (OR 1.52) [70•].…”