Tendon involvement in rheumatoid arthritis of the wrist: MRI findings

Valeri, Gianluca; Ferrara, Calogero; Ercolani, P; Nigris, Enrico De; Giovagnoni, Andrea

doi:10.1007/s002560100322

Cited by 37 publications

(20 citation statements)

References 16 publications

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“…This incidence was much higher than was reported in other cohorts in the literature [25][26][27], which indicated the presence of tenosynovitis in approximately 50-60 % of included patients. In a group of 50 patients with early, untreated RA, Wakefield et al [36] found flexor tenosynovitis in 82% of patients with MRI and in only 48% of patients with US.…”

Section: Discussioncontrasting

confidence: 51%

“…Some studies regarding US incidence [25][26][27], validity [13] and inter-observer reliability of US detection of tenosynovitis involving multiple investigators [28][29][30][31] have been performed. Tenosynovitis has been included together with synovitis without separation between joints and tendons' pathology in some described US scores [32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

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Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy

Vlad

Berghea

Micu³

et al. 2015

Med Ultrason

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Aims: To investigate by ultrasonography (US) in a cohort of active RA patients starting biologic therapy the responsiveness of tenosynovitis of wrist and hands compared to the responsiveness of synovitis in a 6 month period follow-up, to compare the responsiveness of finger flexor tenosynovitis with the responsiveness of wrist extensor tenosynovitis and to describe the subclinical synovitis and tenosynovitis in RA patients in clinical remission. Material and methods: Fifty seven patients with active RA starting biologic therapy were included. Clinical, laboratory, and US evaluations were performed at baseline, 1, and 6 months. US evaluation included wrist and MCPs 2-5 joints, bilaterally for synovitis and extensor tendons compartments 2, 4, and 6 and finger flexors 2-5 for tenosynovitis. Eighteen US scores based on semiquantitative or binar grades were calculated at each visit. Responsiveness of synovitis and tenosynovitis scores was calculated using the standardized response mean (SRM). Results: The responsiveness of US tenosynovitis was lower comparing with the responsiveness of US synovitis but both showed large effect of therapy. Furthermore, tenosynovitis responsiveness was similar to CRP responsiveness (SRM -0.90). Finger flexors tenosynovitis showed a higher responsiveness than extensor tenosynovitis on GS (-0.94 compared to -0.63) and a lower SRM on PD (-0.56 compared to -0.85). Tenosynovitis scores remission was overlapping clinical remission according to CDAI and SDAI in 100% of cases. Overall there was less subclinical tenosynovitis than subclinical synovitis at final visit according to clinical activity indices. Conclusion: Tenosynovitis US scoring in RA may be as good as synovitis scoring for characterization of disease activity and responsiveness.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy

Vlad

Berghea

Micu³

et al. 2015

Med Ultrason

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“…An interesting point of difference between lupus-associated Jaccoud's arthropathy and RA is that the flexor tendons are more often involved in the 748 McQUEEN ET AL former condition, as opposed to extensor tendons in the latter (20). Although we did not investigate healthy subjects in this study, MRI scans from normal subjects have been studied by others (3,10). Small amounts of fluid in 1 or more dorsal wrist compartments have been described, with rare examples of increased signal intensity within the substance of tendons, but pannus has not been identified.…”

Section: Discussionmentioning

confidence: 93%

“…Hypertrophy of the tenosynovium within the tendon sheath is revealed as bright signal in thickened tissue surrounding a tendon on T1-weighted postcontrast and T2-weighted sequences, while an accompanying effusion within the sheath is low signal on early T1-weighted postcontrast scans. Changes within the tendon itself can be identified and include increased signal on T2-weighted images implying inflammatory change, as well as thinning and attenuation, which are likely to precede rupture (7,10). MRI identification of tendon rupture is highly correlated with surgical confirmation and has been shown to be more accurate than clinical evaluation (3).…”

mentioning

confidence: 99%

Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years

McQueen¹,

Beckley²,

Crabbe³

et al. 2005

Arthritis & Rheumatism

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Objective. To determine whether magnetic resonance imaging (MRI) evidence of tendinopathy in early rheumatoid arthritis (RA) could be used to predict the course of tendon involvement in later disease and specifically the risk of tendon rupture.Methods. The occurrence, pattern, and progression of tendinopathy were studied prospectively over 6 years in a cohort of patients who had presented with RA. Of 42 patients enrolled, full MRI and clinical data were available for 31 at 6 years. MRI scans of the dominant wrist were scored for tendinopathy by 2 radiologists using a validated system. These data were compared with MRI synovitis, erosion scores, and disease activity measures. Prognostic factors for tendon inflammation and rupture were sought.Results. Thirty-four patients (81%) had MRI evidence of tendinopathy at baseline, falling to 59% at 1 year and 68% at 6 years. The most commonly affected site was the extensor carpi ulnaris. MRI tendinopathy and synovitis scores were correlated at baseline (r ‫؍‬ 0.37, P ‫؍‬ 0.01) and 1 year (r ‫؍‬ 0.45, P ‫؍‬ 0.003) but not at 6 years (r ‫؍‬ 0.11, P ‫؍‬ 0.5). The strongest predictor of the 6-year tendinopathy score was the 1-year tendinopathy score ( Conclusion. MRI can be used to quantify tendinopathy at the wrist in RA patients. High scores in early disease were predictive of tendon rupture in a small group of patients, but further studies are required to determine whether this has clinical relevance.Tendinopathy involving the extensor tendons of the wrist is observed in 50-64% of patients with rheumatoid arthritis (RA) (1). An important complication is tendon rupture, which has been related both to invasion of the tendon by tenosynovial pannus and fraying of the tendon against eroded bone margins (2,3). Studies of invasive tenosynovium have revealed high levels of matrix metalloproteinases, proinflammatory cytokines, and angiogenic factors, indicating a propensity for damage to neighboring tissues (4). The importance of ongoing tenosynovial inflammation in promoting tendon rupture has been confirmed by observations that prophylactic dorsal tenosynovectomy can prevent this complication in many patients (5). However, the decision to perform surgery is usually made in established cases of RA once

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“…Clinical evaluation of tenosynovitis is difficult and conventional radiography is not useful. MRI is a technique that allows good visualisation and assessment of inflammatory changes in the tendons and tendon sheaths 2 3…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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Tendon involvement in rheumatoid arthritis of the wrist: MRI findings

Abstract: Low grades of peritendinous effusion were more common in the volar compartment whereas moderate and high degrees of tendon sheath fluid collection and/or pannus and signs of tendonitis were more frequent in the dorsal and ulnar tendon sheaths.

Cited by 37 publications

References 16 publications

Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy

Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy

Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years

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

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