Role of metacarpophalangeal joint anatomic factors in the distribution of synovitis and bone erosion in early rheumatoid arthritis

Tan, Ai Lyn; Tanner, Steven F.; Conaghan, Philip G.; Radjenovic, Aleksandra; O’Connor, Philip; Brown, Andrew; Emery, Paul; McGonagle, Dennis

doi:10.1002/art.10963

Cited by 111 publications

(76 citation statements)

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“…We found that healthy subjects had a measurable, but only minimal, early enhancement in the synovial compartment as assessed by dynamic MRI. This is consistent with data reported recently by Tan et al, showing some low-grade early enhancement in normal joints (15).…”

Section: Discussionsupporting

confidence: 94%

“…Furthermore, in these studies, the MR images are most often obtained and evaluated in 1 plane only (6,8,(10)(11)(12)(13)(14), increasing the risk of misinterpretations, particularly due to partial volume artifacts being wrongly interpreted as erosive changes or synovitis. Bone marrow edema was assessed in only a few studies (6)(7)(8)11), and only 1 report describes dynamic contrast-enhanced MRI of MCP joints in the peripheral joints of healthy persons (15). The objectives of the present study were 1) to explore the presence of bone changes resembling erosions, bone marrow edema, and soft tissue changes resembling synovitis in MCP and wrist joints of healthy persons on MR images obtained and evaluated according to the latest recommendations of the international initiative to harmonize outcome measures in rheumatology (Outcome Measures in Rheumatology Clinical Trials [OMERACT]) (16); and 2) to compare the MRI findings with conventional radiographic, clinical, and biochemical findings.…”

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confidence: 99%

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Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis

Ejbjerg

Narvestad

Rostrup

et al. 2004

Arthritis & Rheumatism

162

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Objective. To explore the presence of changes resembling rheumatoid arthritis erosions and synovitis in metacarpophalangeal (MCP) and wrist joints of healthy individuals on magnetic resonance imaging (MRI) and to compare the MRI findings with conventional radiographic, clinical, and biochemical findings.Methods. Twenty-eight healthy individuals were studied. Contrast-enhanced MRI and conventional radiography of the dominant wrist and second through fifth MCP joints were performed, coupled with standard clinical assessments and biochemical analyses. MR images were evaluated according to the latest OMER-ACT (Outcome Measures in Rheumatology Clinical Trials) recommendations with respect to synovitis, erosions, and bone marrow edema.Results. Conventional radiography revealed erosion-like changes in 1 of 224 MCP joint bones (0.4%) and in 1 of 420 wrist joint bones (0.2%). MRI depicted low-grade erosion-like changes in 5 of 224 MCP joint bones (2.2%) and in 7 of 420 wrist joint bones (1.7%), but postcontrast enhancement within the lesion was detected in only 8.3% of these. MRI depicted low-grade synovitis-like changes in 10 of 112 MCP joints (8.9%) and in 8 of 84 assessed wrist areas (9.5%), while only minimal early synovial enhancement was detected by dynamic MRI. Three subjects had elevated serum levels of C-reactive protein, and these subjects displayed 44.5% of the synovitis-like changes and 41.7% of the erosion-like changes. Bone marrow edema-like changes were not found in any joints.Conclusion. Changes resembling mild synovitis or small bone erosions are occasionally found in the MCP and wrist joints of healthy controls. Signs of synovitis on dynamic MRI, enhancement within bone erosion-like changes, and signs of bone marrow edema appear rarely or are absent in healthy controls. These signs may thus prove to be very specific in the distinction between arthritic and normal joints.Conventional radiography is the standard reference method for assessing destructive skeletal changes in rheumatoid arthritis (RA) and is part of the American College of Rheumatology (formerly, the American Rheumatism Association) 1987 revised criteria for the classification of RA (1). Magnetic resonance imaging (MRI) is more sensitive for the detection of synovitis and bone erosions in RA than are conventional radiography and clinical assessment (2-4). However, the specificity of the MRI findings in this context remains to be established.A review of the literature describing erosions, synovitis, and bone marrow edema in wrist and metacarpophalangeal (MCP) joints on MRI revealed that very few studies have assessed the prevalence of these findings in healthy persons (Table 1). To our knowledge, only one reported study had the primary aim of describing signs of arthritis in healthy persons. Investigators in that study only examined signs of synovitis in wrist joints (5).Studies involving healthy controls are often perSupported by the Danish Rheumatism Association.

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Section: Discussionsupporting

confidence: 94%

mentioning

confidence: 99%

Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis

Ejbjerg

Narvestad

Rostrup

et al. 2004

Arthritis & Rheumatism

162

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“…We have previously utilized magnetic resonance imaging (MRI) to rekindle interest in another possible microanatomic factor in erosion formation (11). The results from MRI showed that erosion formation in the metacarpophalangeal (MCP) joints of patients with RA is not random but, rather, occurs with a high frequency adjacent to the collateral ligament (CL) origins of the MCP joints, which are also sites of bony compression (11).…”

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confidence: 99%

“…The results from MRI showed that erosion formation in the metacarpophalangeal (MCP) joints of patients with RA is not random but, rather, occurs with a high frequency adjacent to the collateral ligament (CL) origins of the MCP joints, which are also sites of bony compression (11). With the use of MRI in normal individuals, we also noted a small degree of bone damage adjacent to the CLs at the same MCP anatomic location, but the histologic basis for such "erosion-like" changes has not been defined.…”

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confidence: 99%

“…With the use of MRI in normal individuals, we also noted a small degree of bone damage adjacent to the CLs at the same MCP anatomic location, but the histologic basis for such "erosion-like" changes has not been defined. Given that the CLs in MCP joints are relatively large structures, we postulated that synovitis in RA drove the inherent tendency for bone erosion to occur at certain predisposed locations (11).…”

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confidence: 99%

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Microanatomic studies to define predictive factors for the topography of periarticular erosion formation in inflammatory arthritis

McGonagle¹,

Tan²,

Døhn³

et al. 2009

Arthritis & Rheumatism

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Objective. The microanatomic basis for formation of erosions in inflammatory arthritis is incompletely understood but is thought to be related to bare areas and the associated cartilage-synovium junction. The purpose of this study was to test the hypothesis that erosion-prone sites are associated with microdamage in macroscopically normal joints.Methods. Histologic evaluation of erosion-prone sites was performed on 20 collateral ligaments (CLs) from the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of 5 normal cadavers. In addition, the MCP joints (n ‫؍‬ 17) and PIP joints (n ‫؍‬ 3) of 20 patients with rheumatoid arthritis (RA) were assessed by computed tomography (CT) to ascertain whether the topography of erosion formation in patients with RA corresponded to the cadaveric findings.Results. Absence of a bare area was noted in cadaveric tissue at the periligamentous erosion-prone regions, especially in the distal MCP joints and both distal and proximal PIP joints. Nevertheless, these sites exhibited soft-tissue pathologic features and bony microdamage/cyst formation. Other significant findings included the presence of pannus without inflammatory changes in the regions in which a bare area was absent, and the replacement of bare area regions with fibrovascular synovial tissue in joints without inflammatory changes. The sites of cadaveric tissue microdamage corresponded to CT-determined erosion formation in the MCP and PIP joints of patients with RA, in whom erosions adjacent to the CLs were more common than dorsal or volar erosions.Conclusion. Periarticular erosion formation may not necessarily depend on the presence of a bare area and has a propensity to occur adjacent to ligaments in which bone microdamage is common. These findings suggest that periligamentous locations prone to microdamage may critically influence the topography of erosion formation in inflammatory arthritis.

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Tightening Up? Impact of Musculoskeletal Ultrasound Disease Activity Assessment on Early Rheumatoid Arthritis Patients Treated Using a Treat to Target Strategy

Dale

Purves

McConnachie

et al. 2013

Arthritis Care & Research

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Objective.To determine the level of agreement and potential impact on disease-modifying antirheumatic drug (DMARD) escalation decisions and of adding musculoskeletal ultrasound (MSUS) assessment of disease activity to the Disease Activity Score in 28 joints (DAS28) in early rheumatoid arthritis (RA). Methods. Data were gathered from 53 early RA patients randomized to the MSUS assessment group of the Targeting Synovitis in Early Rheumatoid Arthritis study. DAS28 scores were calculated every month. MSUS was performed on patients with low disease activity (DAS28 <3.2) and on those with moderate disease activity (3.2 < DAS28 <5.1) without clinically swollen joints (swollen joint count [SJC] <1). Fourteen joints (bilateral proximal interphalangeal joints 2 and 3, metacarpophalangeal [MCP] joints 2 and 3, the radiocarpal, and metatarsophalangeal joints 2 and 5) were examined. Active disease was defined as >2 joints demonstrating any power Doppler (PD) signal. Data from 414 paired DAS28 and MSUS assessments were pooled to determine the level of agreement between each method. Results. A total of 369 MSUS assessments were conducted on patients with DAS28 <3.2; 92 (25%) of these assessments identified active disease. A total of 271 MSUS assessments were performed on those with DAS28 <2.6; 66 (24%) of these identified active disease. Forty-five MSUS assessments were conducted on patients with 3.2 < DAS28 <5.1 and SJC <1; 15 (33%) of these assessments confirmed active disease. On 120 occasions (29%), MSUS findings contradicted the DAS28 and led to modified treatment decisions. The joints that most frequently exhibited PD signal were radiocarpal and index and middle MCP joints. Conclusion. Compared to the DAS28, global RA disease activity assessment using a limited MSUS joint set provided additional disease activity information and led to altered treatment decisions in a significant minority of occasions. This may allow further tailoring of DMARD therapy by supporting DMARD escalation in patients with continuing subclinical synovitis and preventing escalation in symptomatic patients with minimal clinical and/or ultrasonographic synovitis.

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Role of metacarpophalangeal joint anatomic factors in the distribution of synovitis and bone erosion in early rheumatoid arthritis

Cited by 111 publications

References 33 publications

Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis

Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis

Microanatomic studies to define predictive factors for the topography of periarticular erosion formation in inflammatory arthritis

Tightening Up? Impact of Musculoskeletal Ultrasound Disease Activity Assessment on Early Rheumatoid Arthritis Patients Treated Using a Treat to Target Strategy

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