MRI in rheumatoid arthritis: a useful tool for the clinician?

Abstract

Over the last two decades, MRI has emerged as an important clinical tool to assist in the diagnosis and management of rheumatic disease. In rheumatoid arthritis (RA), MRI has improved our understanding of the pathological basis of disease and has provided new information about imaging features that reflect joint inflammation and damage. Using MRI, we can now directly observe inflammation involving the synovial membrane and tenosynovium, plus joint damage including bone erosion and cartilage thinning. Inflammation of bone beneath the joint (osteitis) appears as bone oedema which is a feature unique to MRI and yields important diagnostic and prognostic information in patients with inflammatory arthritis. With the introduction of biologics to rheumatology clinical practice, sensitive tools are required to monitor disease activity and progression, so that the disease suppressing effect of these new agents can be measured. MRI fits the bill for this role as it can inform the clinician about the development of bone erosions well before plain radiography, and its ability to reveal cartilage damage is emerging. The use of MRI as a marker of outcome in clinical trials is being paralleled by its increasing role in the clinic. Both extremity and high field MRI have clinical applications in RA and need to be considered along with other advanced imaging techniques as useful tools to add to the clinician’s armamentarium. This review will summarise recent advances in this field and will apply current knowledge to specific clinical scenarios relevant to modern rheumatology practice.

The role of magnetic resonance imaging in a patient with rheumatoid arthritis presented with lymphedema-like swelling: a case report

“…Typical features of RA including inflammation of the synovial membrane and tenosynovium, bone erosion, bone marrow edema, thinning of cartilage, and osteitis can be visualized clearly with MRI. [4] As mentioned, lymphedema is a rare complication of RA, but it usually tends to be more widespread than the swelling caused by synovitis. It is believed that lymphedema in RA is either a result of venous obstruction, generalized increase in capillary permeability, or lymphatic obstruction.…”

Specificity Evaluation and Disease Monitoring in Arthritis Imaging with Complement Receptor of the Ig superfamily targeting Nanobodies

“…MRI imaging produces anatomically detailed images of cartilage, tendons, synovial membrane and bone which ultrasonography could not penetrate11. It provides a higher contrast resolution, allowing detection of synovial hyperplasia, cartilage and bone degradation, inflammation and osteitis and is able to show signs of early arthritis in patients24.…”

“…Other molecular probes being developed for molecular arthritis imaging include fluorescence and near-infrared labelled probes26 for optical imaging or radioisotopes labelled probes for scintigraphy, PET or SPECT14. Nuclear imaging techniques generate deeper tissue penetration and lower background than optical imaging techniques and are more sensitive than structural imaging11. In the current study, we built on previous results obtained with NbV4m119 as a probe for molecular imaging of arthritic inflammation23.…”

“…Other non-invasive readouts to monitor disease evolution or treatment efficacy, such as near-infrared, PET or SPECT imaging and scintigraphy, possibly combined with anatomical imaging techniques such as X-ray, ultrasonography and magnetic resonance imaging, can provide information on underlying molecular and cellular inflammatory processes as well as bone destruction. Tracers used for molecular arthritis imaging include 18 F-fluoro-2-deoxy-D-glucose for visualizing glucose metabolism and 99m Tc-methylenediphosphonate for monitoring bone turnover11. Various stroma-targeting tracers have been described for imaging arthritic synovitis, including 99m Tc-anti-E-selectin-Fab for targeting activated endothelium12, radiolabelled antibodies targeting fibroblast activation protein for detection of fibrobolast-like synoviocytes13 or probes targeting activated macrophages such as 18 F-polyethyleneglycol-folate1415 or 111 In-anti-F4/80-A3-116.…”

Office e‐MRI: viewing joints from the inside

“…Synovium, cartilage and tendons can also be studied in detail through this technique. MRI is also being increasingly used in clinical trials as a marker of outcome …”