Magnetic resonance imaging of the hand as an early diagnostic method for rheumatoid arthritis


Cite item

Full Text

Abstract

Aim. To provide the qualitative and quantitative characteristics of changes revealed by the data of magnetic resonance imaging (MRI) of the hand and by those of X-ray study of the hand and foot in patients with early rheumatoid arthritis (ERA).
Subjects and methods. The study enrolled 110 patients (90 females, 20 males; age 49.6 ± 12.2 years) examined in the framework of the RADICAL program at the Research Institute of Rheumatology, Russian Academy of Medical Sciences. The mean duration of the disease was 5.61 ± 3.17 months. The diagnosis of rheumatoid arthritis was established by the 1987 ARA criteria in all the patients on primary standard examination comprising X-ray study of the hand and feet and evaluation by the modified Sharp method. MRI of the hand was performed in all the patients, by assessing the result by the OMERACT-RAMRIS procedure.
Results. Destructive changes (cysts and erosions) evidenced by X-ray study were found in the wrists, metacarpophalangeal articulations (MPA), and foot in 7.27, 8.2, and 13.64%, respectively. MRI revealed destructions in the wrist, MPA, and metacarpal bone base in 50, 60, and 16.36%, respectively. Overall, erosions could be seen on X-ray films and MRI scans in 20.91 and 67.27%, respectively (p < 0.001).
MRI revealed bone edema (osteitis) in 46.4% of the patients; there was no difference in the detection rate between the extremities. MRI synovitis was found in 99% of the patients, the right hand being significantly more commonly affected. Detailed characterization of the changes revealed by MRI and X-ray was obtained in patients with ERA.
Conclusion. MRI detected erosions significantly more frequently than did X-ray (p < 0.001), which confirms the high value of low-field MRI diagnosis on primary examination of patients with ERA and supports the opinion that the results of this study should be included into the diagnostic criteria of ERA.

About the authors

Il'ya Emmanuilovich Rapoport

Email: rapoport@inbox.ru

Elena L'vovna Luchikhina

Elena Yur'evna Pogozheva

Aleksandr Viktorovich Smirnov

Dmitriy Evgen'evich Karateev

I E Rapoport

Research Institute of Rheumatology, Russian Academy of Medical Sciences

Research Institute of Rheumatology, Russian Academy of Medical Sciences

E L Luchikhina

Research Institute of Rheumatology, Russian Academy of Medical Sciences

Research Institute of Rheumatology, Russian Academy of Medical Sciences

E Yu Pogozheva

Research Institute of Rheumatology, Russian Academy of Medical Sciences

Research Institute of Rheumatology, Russian Academy of Medical Sciences

A V Smirnov

Research Institute of Rheumatology, Russian Academy of Medical Sciences

Research Institute of Rheumatology, Russian Academy of Medical Sciences

D E Karateyev

Research Institute of Rheumatology, Russian Academy of Medical Sciences

Research Institute of Rheumatology, Russian Academy of Medical Sciences

References

  1. Gabriel S. E. The epidemiology of rheumatoid arthritis. Rheum. Dis. Clin. N. Am. 2001; 27 (2): 269-281.
  2. Фоломеева О. М., Эрдес Ш. Ф. Ревматические заболевания у взрослого населения в федеральных округах Российской Федерации. Науч.-практ. ревматол. 2006; 2: 4-10.
  3. Насонов Е. Л. Фармакотерапия ревматоидного артрита с позиций доказательной медицины: новые рекомендации. Рус. мед. журн. 2002; 10 (6): 294-302.
  4. Breedveld F. C., Emery P., Keystone E. et al. Infliximab in active early rheumatoid arthritis. Ann. Rheum. Dis. 2004; 63 (2):149-155.
  5. Scali J. J., Visentini S., Salomon J. et al. Rapid and deep control of inflammation in rheumatoid arthritis with infliximab and its correlation with acute-phase reactants. Ann. N. Y. Acad. Sci. 2007; 1110: 389-401.
  6. O'Dell J. R. The Best way to treat early rheumatoid arthritis? Ann. Intern. Med. 2007; 146 (6): 459-460.
  7. Arnett F. C., Edworthy S. M., Bloch D. A. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthr. and Rheum. 1988; 31 (3): 315-324.
  8. Ejbjerg B. J., Vestergaard A., Jacobsen S. et al. Conventional radiography requires a MRI-estimated bone volume loss of 20% to 30% to allow certain detection of bone erosions in rheumatoid arthritis metacarpophalangeal joints. Arthr. Res. Ther. 2006; 8 (3): R59.
  9. Devauchelle Pensec V., Saraux A., Berthelot J. M. et al. Ability of hand radiographs to predict a further diagnosis of rheumatoid arthritis in patients with early arthritis. J. Rheumatol. 2001; 28: 2603-2607.
  10. Paulus H. E., Oh M., Sharp J. T. et al. Correlation of single time-point damage scores with observed progression of radiographic damage during the first 6 years of rheumatoid arthritis. J. Rheumatol. 2003; 30: 705-713.
  11. Ejbjerg B. J., Vestergaard A., Jacobsen S. et al. The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist, and toe joints: a comparison of the OMERACT rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the Sharp/van der Heijde radiographic score. Arthr. and Rheum. 2005; 52 (8): 2300-2306.
  12. Olech E., Freeston J. E., Conaghan P. G. et al. Using extremity magnetic resonance imaging to assess and monitor early rheumatoid arthritis: the optimal joint combination to be scanned in clinical practice. J. Rheumatol. 2008; 35 (4): 580-583.
  13. Valesini G., Di Franco M., Spinelli F. R. et al Induction of remission in rheumatoid arthritis: criteria and opportunities. Rheumatol. Int. 2008; 29: 131-139.
  14. Ostergaard M., Peterfy C., Conaghan P. et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J. Rheumatol. 2003; 30 (6): 1385-1386.
  15. Ostergaard M., Conaghan P., ed. The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann. Rheum. Dis. 2005; 64 (suppl. 1): i3-i55.
  16. Meller Dohn U., Boonen A., Hetland M. L. et al. Erosive progression is minimal, but erosion healing rare, in rheumatoid arthritis patients treated with adalimumab. A 1 year investigator-initiated follow-up study using high-resolution computed tomography as the primary outcome measure. Ann. Rheum. Dis. 2009; 68 (10): 1585-1590.
  17. Брюханов А. В., Васильев А. Ю. Магнитно-резонансная томография в диагностике заболеваний суставов. Барнаул; 2001.
  18. Васильев А. Ю., Обраменко И. Е., Железинская Н. В. Комплексная лучевая диагностика ревматоидного артрита лучезапястного сустава и кисти на ранних стадиях заболевания. Мед. визуализация 2007; 2: 115-119.
  19. Каратеев Д. Е., Лучихина Е. Л., Тюрина Л. Н. и др. Возможности ранней диагностики ревматоидного артрита в клинической практике на современном этапе (результаты наблюдений за московской когортой больных ранним артритом в рамках программы РАДИКАЛ). Тер. арх. 2008; 80 (5): 8-13.
  20. Каратеев Д. Е., Олюнин Ю. А. К вопросу о классификации ревматоидного артрита. Науч.-практ. ревматол. 2008; 1: 5-16.
  21. van der Heijde D. M., van Riel P. L., Nuver-Zwart I. H. et al. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1989; 1 (8646): 1036-1038.
  22. Ostergaard M., Dohn U. M., Ejbjerg B. J., McQueen F. M. Ultrasonography and magnetic resonance imaging in early rheumatoid arthritis: recent advances. Curr. Rheumatol. Rep. 2006; 8: 378-385.
  23. McQueen F. M., Stewart N., Crabbe J. et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann. Rheum. Dis. 1998; 57: 350-356.
  24. Ostendorf B., Scherer A., Modder U., Schneider M. Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis whenfindings on imaging of the metacarpophalangeal joints of the hands remain normal. Arthr. and Rheum. 2004; 50: 2094-2102.
  25. Perry D., Stewart N., Benton N. et al. Detection of erosions in the rheumatoid hand; a comparative study of multidetector computerized tomography versus magnetic resonance scanning. J. Rheumatol. 2005; 32: 256-267.
  26. Dohn U. M., Ejbjerg B. J., Hasselquist M. et al. Rheumatoid arthritis bone erosion volumes on CT and MRI: reliability and correlations, with erosion scores on CT, MRI and radiography. Ann. Dis. 2007; 66: 1388-1392.
  27. Jimenez-Boj E., Nobauer-Huhmann I., HansHk-Schnabel B. et al. Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthr. and Rheum. 2007; 56 (4): 1118-1124.
  28. Duer-Jensen A., Ejbjerg B., Albrecht-Beste E. et al. Does low-field dedicated extremity MRI (E-MRI) reliably detect RA bone erosions? A comparison of two different E-MRI units and conventional radiography with high resolution CT. Ann. Rheum. Dis. 2009; 68 (8): 1296-1302.
  29. Dohn U. M., Ejbjerg B. J., Hasselquist M. et al. Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography. Arthr. Res. Ther. 2008; 10 (1): R25.
  30. Duer-Jensen A., Vestergaard A., Dohn U. M. et al. Detection of rheumatoid arthritis bone erosions by two different dedicated extremity MRI units and conventional radiography. Ann. Rheum. Dis. 2008; 67 (7): 998-1003.
  31. Yoshioka H., Ito S., Handa S. et al. Low-field compact magnetic resonance imaging system for the hand and wrist in rheumatoid arthritis. J. Magn. Reson. Imag. 2006; 23 (3): 370- 376.
  32. Hirose W., Nishikawa K., Hirose M. et al. Response of early active rheumatoid arthritis to tumor necrosis factor inhibitors: evaluation by magnetic resonance imaging. Mod. Rheumatol. 2009; 19 (1): 20-26.
  33. Tamai M., Kawakami A., Uetani M. et al. Bone edema determined by magnetic resonance imaging reflects severe disease status in patients with early-stage rheumatoid arthritis. J. Rheumatol. 2007; 34 (11): 2154-2157.
  34. Solau-Gervais E., Legrand J. L., Cortet B. et al. Magnetic resonance imaging of the hand for the diagnosis of rheumatoid arthritis in the absence of anticyclic citrullinated peptide antibodies: a prospective study. J. Rheumatol. 2006; 33 (9): 1760- 1765.
  35. Tamai M., Kawakami A., Uetani M. et al. The presence of anti-cyclic citrullinated peptide antibody is associated with magnetic resonance imaging detection of bone marrow oedema in early stage rheumatoid arthritis. Ann. Rheum. Dis. 2006; 65 (1): 133-134.
  36. Hetland M. L., Ejbjerg B. J., Horslev-Petersen K. et al. MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2 year randomized controlled trial (CIMESTRA). Ann Rheum Dis. Advance Access published April 3, 2008, doi: 10.1136/ard.2008.088245.
  37. McQueen F. M., Ostendorf B. What is MRI bone oedema in rheumatoid arthritis and why does it matter? Arthr. Res.Ther. 2006; 8 (6): 222.
  38. Benton N., Stewart N., Crabbe J. et al. MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann. Rheum. Dis. 2004; 63 (5): 555-561.
  39. Palosaari K., Vuotila J., Takalo R. et al. Bone oedema predicts erosive progression on wrist MRI in early RA - a 2-yr observational MRI and NC scintigraphy study. Rheumatology (Oxford) 2006; 45 (12): 1542-1548.
  40. Boesen M., Boesen L., Jensen K. E. et al. Clinical outcome and imaging changes after intraarticular (IA) application of etanercept or methylprednisolone in rheumatoid arthritis: magnetic resonance imaging and ultrasound-Doppler show no effect of IA injections in the wrist after 4 weeks. J. Rheumatol. 2008; 35 (4): 584-589.
  41. Narvaez J., Sirvent E., Narvaez J. A. et al. Usefulness of magnetic resonance imaging of the hand versus anticyclic citrullinated peptide antibody testing to confirm the diagnosis of clinically suspected early rheumatoid arthritis in the absence of rheumatoid factor and radiographic erosions. Semin. Arthr. Rheum. 2008; 38 (2): 101-109.
  42. Погожева Е. Ю. Клинико-инструментальная характеристика ревматоидного артрита на ранней стадии: Дис. ... канд. мед. наук. М.; 2009.
  43. Brown A. K., Quinn M. A., Karim Z. et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthr. and Rheum. 2006; 54: 3761-3773.
  44. Ejbjerg B., Narvestad E., Rostrup E. et al. Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis. Arthr. and Rheum. 2004; 50: 1097-1106.
  45. McQueen F. M., Stewart N., Crabbe J. et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prgyajence of erosions at four months after symptom onset. Ann. Rheum. Dis. 1998; 57: 350-356.
  46. Marckmann P., Skov L., Rossen K. et al. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J. Am. Soc. Nephrol. 2006; 17 (9): 2359-2362.
  47. Yerram P., Saab G., Karuparthi P. R. et al. Nephrogenic systemic fibrosis: a mysterious disease in patients with renal failure - role of gadolinium-based contrast media in causation and the beneficial effect of intravenous sodium thiosulfate. Clin. J. Am. Soc. Nephrol. 2007; 2 (2): 258-263.
  48. Wertman B. R., Altun E., Martin D. R. et al. Risk of nephrogenic systemic fibrosis: evaluation of gadolinium chelate contrast agents at four American universities. Radiology 2008; 248 (3): 799-806.
  49. Broome D. R., Girguis M. S., Baron P. W. et al. Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned. Am. J. Roentgenol. 2007; 188 (2): 586- 592.
  50. Steen H., Giannitsis E., Sommerer C. et al. Acute phase reaction to gadolinium-DTPA in dialysis patients. Nephrol. Dial. Transplant. 2009; 24 (4): 1274-1277.
  51. Rinck P. A. Radiologists meet with heavy collateral damage. Diagn. Imag. Europe 2008; 24 (7): 19-22.
  52. Ostergaard M., Haesen M., Stoltenberg M. et al. Quantitative assessment of the synovial membrane in the rheumatoid wrist: an easily obtained MRI score reflects the synovial volume. Br. J. Rheumatol. 1996; 35: 965-971.
  53. Marzo-Ortega H., Rhodes L. A., Tan A. L. et al: Evidence for a different anatomic basis for joint disease localization in polymyalgia rheumatica in comparison with rheumatoid arthritis. Arthr. and Rheum. 2007; 56: 3496-3501.
  54. McGonagle D., Pease C., Marzo-Ortega H. et al. Comparison of extracapsular changes by magnetic resonance imaging in patients with rheumatoid arthritis and polymyalgia rheumatica. J. Rheumatol. 2001; 28: 1837-1841.
  55. McGonagle D., Khan M. A., Marzo-Ortega H. et al. Enthesitis in spondyloarthropathy. Curr . Opin. Rheumaiol. 1999; 11: 244-250.
  56. Tan A. L., Grainger A. J., Tanner S. F. et al. A high resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthr. and Rheum. 2006; 54: 1328-1333.
  57. Tan A. L., Grainger A. J., Tanner S. F. et al. High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthr. and Rheum. 2005; 52: 2355-2365.
  58. Haavardsholm E. A., Ostergaard M., Ejbjerg B. J. et al. Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study. Ann. Rheum. Dis. 2007; 66 (9): 1216-1220.
  59. Wakefield R. J., O'Connor P. J., Conaghan P. G. et al. Finger tendon disease in untreated early rheumatoid arthritis: A comparison of ultrasound and magnetic resonance imaging. Arthr. and Rheum. 2007; 57 (7): 1158-1164.
  60. McQueen F. M., Dalbeth N., Doyle A. MRI in psoriatic arthritis: insights into pathogenesis and treatment response. Curr. Rheumatol. Rep. 2008; 10 (4): 303-310.
  61. Healy P. J., Groves C., Chandramohan R., Helliwell P. S. MRI changes in psoriatic dactylitis: extent of pathology, relationship to tenderness and correlation with clinical indices. Rheumatology 2008; 47: 92-95.
  62. Olivieri I., D'Angelo S., Scarano E., Padula A. What is the primary lesion in SpA dactylitis? Rheumatology (Oxford) 2008; 47 (5): 561-562.
  63. Duer A., Ostergaard M., Horslev-Petersen K. et al. Magnetic resonance imaging and bone scintigraphy in the differential diagnosis of unclassified arthritis. Ann. Rheum. Dis. 2008; 67: 48-51.
  64. McQueen F., Lassere M., Bird P. et al. Developing a magnetic resonance imaging scoring system for peripheral psoriatic arthritis. J. Rheumatol. 2007; 34 (4): 859-861.
  65. Helliwell P. S., Firth J., Ibrahim G. H. et al. Development of an assessment tool for dactylitis in patients with psoriatic arthritis. J. Rheumatol. 2005; 32: 1745-1750.
  66. Mottonen T. T. Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis. Ann. Rheum. Dis. 1988; 47 (8): 648-653.
  67. Jacobson J. A., Girish G., Jiang Y. et al. Radiographic evaluation of arthritis: inflammatory conditions. Radiology 2008; 248 (2): 378-389.
  68. Sahin F., Kotevoglu N., Taspinar S. et al. Comparison of functional disability scales and their relevance to radiological progression in patients with rheumatoid arthritis in remission. Clin. Exp. Rheumatol. 2006; 24 (5): 540-545.
  69. Sharp J. T., Angwin J., Boers M. et al Computer based methods for measurement of joint space width: update of an ongoing OMERACT project J. Rheumatol. 2007; 34 (4): 874-883.
  70. Finckh A., de Pablo P., Katz J. N. et al. Performance of an automated computer-based scoring method to assess joint space narrowing in rheumatoid arthritis: a longitudinal study. Arthr. and Rheum. 2006; 54 (5): 1444-1450.
  71. Angwin J., Lloyd A., Heald G. et al. Radiographic hand joint space width assessed by computer is a sensitive measure of change in early rheumatoid arthritis. J. Rheumatol. 2004; 31 (6): 1050-1061.
  72. Sharp J. T., van Der Heijde D., Boers M. et al. Repair of erosions in rheumatoid arthritis does occur. Results from 2 studies by the OMERACT Subcommittee on Healing of Erosions. J. Rheumatol. 2003; 30: 1102-1107.
  73. Rau R., Wassenberg S., Herborn G. et al. Identification of radiologic healing phenomena in patients with rheumatoid arthritis. J. Rheumatol. 2001; 28 (12): 2608-2615.
  74. Dohn U. M., Ejbjerg B. J., Court-Payen M. et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthr. Res. Ther. 2006; 8 (4): R110.
  75. Stewart N. R., Crabbe J. P., McQueen F. M. Magnetic resonance imaging of the wrist in rheumatoid arthritis: demonstration of progression between 1 and 6 years. Skeletal Radiol. 2004; 33 (12): 704-711.
  76. Larsen A. Identification of radiologic healing phenomena in patients with rheumatoid arthritis. Letter to editor. J. Rheumatol. 2002; 29 (8): 1800.
  77. McGonagle D., Tan A. L. What magnetic resonance imaging has told us about the pathogenesis of rheumatoid' arthritis- the first 50 years. Arthr. Res. Ther. 2008; 10 (5): 222.
  78. Sugimoto H., Takeda A., Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology 2000; 216: 569-575.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2010 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies