MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions

Abstract

The aim of this study was to assess the ability of MRI determined synovial volumes and bone marrow oedema to predict progressions in bone erosions after 1 year in patients with different types of inflammatory joint diseases. Eighty-four patients underwent MRI, laboratory and clinical examination at baseline and 1 year later. Magnetic resonance imaging of the wrist and finger joints was performed in 22 patients with rheumatoid arthritis less than 3 years (group 1) who fulfilled the American College of Rheumatology (ACR) criteria for rheumatoid arthritis, 18 patients with reactive arthritis or psoriatic arthritis (group 2), 22 patients with more than 3 years duration of rheumatoid arthritis, who fulfilled the ACR criteria for rheumatoid arthritis (group 3), and 20 patients with arthralgia (group 4). The volume of the synovial membrane was outlined manually before and after gadodiamide injection on the T1-weighted sequences in the finger joints. Bones with marrow oedema were summed up in the wrist and fingers on short-tau inversion recovery sequences. These MRI features was compared with the number of bone erosions 1 year later. The MR images were scored independently under masked conditions. The synovial volumes in the finger joints assessed on pre-contrast images was highly predictive of bone erosions 1 year later in patients with rheumatoid arthritis (groups 1 and 3). The strongest individual predictor of bone erosions at 1-year follow-up was bone marrow oedema, if present at the wrist at baseline. Bone erosions on baseline MRI were in few cases reversible at follow-up MRI. The total synovial volume in the finger joints, and the presence of bone oedema in the wrist bones, seems to be predictive for the number of bone erosions 1 year later and may be used in screening. The importance of very early bone changes on MRI and the importance of the reversibility of these findings remain to be clarified.

Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis when findings on imaging of the metacarpophalangeal joints of the hands remain normal

“…In this context, MRI has become a valuable technique for early detection of bone erosions in RA (9). Reports of osteodestruction being detected by conventional radiography earlier and more frequently in the foot than in the hand joints (15)(16)(17) provide accumulating evidence that the foot may be primarily affected in the early stages of RA.…”

“…Bone edema is known as a very early marker of inflammation and, in addition to synovitis, as a strong individual predictor of bone erosion in the MRI evaluation of hand RA, carrying a 6.5-fold risk of bone damage at the same site within 1 year (25,28). Longitudinal studies of patients with early RA showed that the total synovial volume in the finger joints and the presence of bone edema seem to be predictive of the number of bone erosions 1 year later and may be used in screening (9). As shown in our study, bone edema seems to be a typical MRI feature in patients with early RA, which usually 2100 OSTENDORF ET AL might not be found in patients with only nonspecific arthralgia (29).…”

Magnetic resonance imaging of psoriatic arthritis: Insight from traditional and three-dimensional analysis

“…In RA the early synovial proliferation preceded the erosions at the bone capsule interface [7,9,10•,30,31]. The erosion with adjacent BME were shown in RA to more likely progress than those without BME [31,32]. In PsA the entheseal bone marrow and soft tissue edema have been suggested to precede erosions, however, these suggestions need to be proved [4,12•].…”

The impact of MRI on the clinical management of inflammatory arthritides

“…Various studies have reported that MRI pathology (synovitis, bone erosions or, most often, BME) of the wrist and MCP joints at disease onset in early RA predicts radiographic erosions [108,[126][127][128][129][130][131][132][133][134]. Some looked at the short-term predictive value of MRI after 1 year [108,126,128,130,131], whereas other studies had 2 [128,132], 3 [134], 5 [133], 6 [127], or 10 years [129] of follow-up.…”

“…Some looked at the short-term predictive value of MRI after 1 year [108,126,128,130,131], whereas other studies had 2 [128,132], 3 [134], 5 [133], 6 [127], or 10 years [129] of follow-up. All studies found MRI to be a highly significant predictor of radiographic erosions.…”