The rheumatoid wrist: Bilateral MR analysis of the distribution of rheumatoid lesions in axial plan in a female population

Abstract

In this case-control study, we analyzed 146 wrists: a) to search for the distribution pattern of the rheumatoid lesions and, b) to correlate the distribution pattern of these lesions with the clinical parameters. Thirty-one patients with rheumatoid arthritis (RA) and 42 controls-all women-were examined by means of a bilateral MR fast field echo (FFE) sequence, in axial plan. The wrist was divided into three regions: metacarpal (level I), carpal (level II) and radioulnar (level III). Erosions were present in thirty (97%) patients and in six (14%) controls. They were asymmetrically distributed at all levels, mainly at level II. Marrow infiltration and bone destruction were seen in 35% of the patients in an asymmetrical pattern at level I and II, respectively. These lesions were absent in the control group. Subchondral cysts were asymmetrically present in both groups-in 48% of the patients at levels II and III, and in 11% of the controls at level II. In the patient group, this asymmetrical pattern of the lesions correlated with the disease duration at levels I and II (p = 0.011 and p = 0.013, respectively). Most lesions were found at the radial force-bearing column of the wrist, more in the right side. Synovial hypertrophy and hyperintense median nerve were evident in 96% and 70% of the patients, respectively. We concluded that contrary to common belief rheumatoid damages to the carpal bones become rather asymmetrical as the disease progresses. The line of force along the radial side of the wrist possibly influences the distribution pattern of the rheumatoid lesions.

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

“…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).…”

“…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.…”

Advanced imaging of early rheumatoid arthritis

“…A study of wrists in 31 women who had RA and 42 female controls showed that erosions were present in 97% of patients who had RA [58]. In this study, most lesions were found at the radial force-bearing column of the wrist and more erosions were present on the right side.…”

“…In this study, most lesions were found at the radial force-bearing column of the wrist and more erosions were present on the right side. The study found that 14% of controls also showed erosions [58]. Other studies, however, showed no erosions in controls [59,60].…”

Upper Extremity Compression Neuropathies in Rheumatoid Patients

“…Magnetic resonance imaging (MRI) is a valuable adjunct in assessing the anatomic characteristics of the carpal tunnel as well as the degree of synovial proliferation [ 35 ]. Pierre-Jerome et al [ 36 ] noted that 96 and 70 % of patients with RA undergoing a wrist MRI demonstrated synovial hypertrophy and a hyperintense signal in the median nerve.…”