The value of MRI examination on bilateral hands including proximal interphalangeal joints for disease assessment in patients with early rheumatoid arthritis: a cross-sectional cohort study

Abstract

BackgroundBilateral hands including proximal interphalangeal joints (PIPJs) are recommended on physical, X-ray radiographic, or ultrasonographic examination by clinical guidelines of rheumatoid arthritis (RA), but MRI still tends to examine unilateral wrists and/or MCPJs. We aimed to demonstrate the advantages of MRI examination on bilateral hands including PIPJs for disease assessment in early RA patients.MethodsActive early RA patients received 3.0T whole-body MRI examination with contrast-enhanced imaging on bilateral wrists, MCPJs, and PIPJs. MRI features were scored referring to the updated RAMRIS. Clinical assessments were conducted on the day of MRI examination.ResultsThe mean time of MRI examination was 24 ± 3 min. MRI bone erosion in MCPJs would be missed-diagnosed in 23% of patients if non-dominant MCPJs were scanned unilaterally, while osteitis in MCPJs would be missed-diagnosed in 16% of patients if dominant MCPJs were scanned unilaterally. MRI synovitis severity was also asymmetric: 21% of patients showing severe synovitis unilaterally in non-dominant MCPJs/PIPJs and other 20% showing severe synovitis unilaterally in dominant MCPJs/PIPJs. Among these early RA patients, MRI tenosynovitis occurred the most frequently in wrist extensor compartment I, while MRI examination on bilateral hands demonstrated no overuse influence present. However, overuse should be considered in dominant PIPJ2, PIPJ4, and IPJ of thumb of which MRI tenosynovitis prevalence was respectively 18%, 17%, or 16% higher than the non-dominant counterparts. Early MRI abnormality of nervus medianus secondary to severe tenosynovitis occurred either in dominant or non-dominant wrists; MRI of unilateral hands would take a risk of missed-diagnosis. Common MRI findings in PIPJs were synovitis and tenosynovitis, respectively in 87% and 69% of patients. MRI tenosynovitis prevalence in IPJ of thumb or PIPJ5 was much higher than the continued wrist flexor compartments. MRI synovitis or tenosynovitis in PIPJs independently increased more than twice probability of joint tenderness (OR = 2.09 or 2.83, both p < 0.001).ConclusionsIn consideration of asymmetric MRI features in early RA, potential overuse influence for certain tenosynovitis in dominant hands, and high prevalence of MRI findings in PIPJs, MRI examination on bilateral hands including PIPJs is deserved for disease assessment in early RA patients.

Value of imaging detected joint inflammation in explaining fatigue in RA at diagnosis and during the disease course: a large MRI study

“…Reassuringly, previous literature showed that bilateral scanning conveyed little additional information compared with scanning of only the most affected side. 18 19 Although it is a limitation that not more joints were imaged, we think it is unlikely that it majorly affected our results.…”

Neglected extra-articular manifestations in rheumatoid arthritis patients with normal body mass index: reduced skeletal muscle overlapping overfat

“…Demographic and clinical data were collected at enrollment, including age, sex, disease duration, smoking habits, previous medications, comorbidities, disease activity, physical function, and radiographic indicators, as we described previously. 15 , 16 Clinical data included disease duration, 28-joint tender and swollen joint count (28TJC and 28SJC), patient and provider global assessment of disease activity (PtGA and PrGA; range 0–10 cm), pain visual analogue scale (Pain VAS; range 0–10 cm), erythrocyte sedimentation rate [ESR; normal range 0–20 mm/h (female), 0–15 mm/h (male)], C-reactive protein (CRP; normal range 0–5 mg/L), rheumatoid factor (RF; normal range 0–20 mg/L, determined by nephelometry, Siemens Healthcare Diagnostics, Munich, Germany), and anti-cyclic citrullinated peptide antibody (ACPA, normal range 0–18 IU/mL, measured by enzyme-linked immunosorbent assay, Aesku Diagnostics, Wendelsheim, Germany). Disease activity was assessed with disease activity score in 28 joints with four variables including CRP (DAS28-CRP), simplified disease activity index (SDAI) and clinical disease activity index (CDAI).…”

“…Radiographs were assessed according to the Sharp/van der Heijde modified score, 20 using the average scores of two experienced readers (ZHY from Radiology and LFC from Rheumatology) who were blinded to clinical data as we described previously. 15 , 16 Sixteen areas for joint erosion (JE) and 15 for joint space narrowing (JSN) of hands were assessed in each hand/wrist. The maximum score per single joint for JE is 5, and for JSN is 4, with the sum of JE (0–160) and JSN (0–120) subscores constituting modified total Sharp score (mTSS; 0–280).…”

“…Therapeutic Advances in Chronic Disease 11 16 journals.sagepub.com/home/taj Sun Yat-sen Memorial Hospital, who kindly provided statistical advice for this manuscript.…”

Exames complementares das entesopatias. Parte 4 – Imagem: ressonância magnética

“…Isso, de fato, torna-se um problema em pacientes que farão exame em mais de um segmento anatômico, já que a segunda articulação, invariavelmente, terá uma aquisição pós-contraste tardia e o diagnóstico de sinovite será prejudicado. Diante disso, alguns protocolos de RM foram criados a fim de suplantar este problema, como, por exemplo, a aquisição simultânea e bilateral das imagens das mãos e dos punhos em um campo de visão único, que tem como benefício adicional um tempo de exame mais curto (Figura 2) 18,19 . Diferente do exame simultâneo das mãos e punhos dos pacientes com AR, nos pacientes com suspeita de EpA, é recomendado incluir as articulações interfalângicas distais no campo de visão devido a seu envolvimento frequente.…”