Ann Rheum Dis 1999;58:156-163 ( March )

Extended reports

Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement Fiona M McQueen, Neal Stewart, Jeff Crabbe, Elizabeth Robinson, Sue Yeoman, Paul L J Tan, Lachy McLean

Department of Molecular Medicine, Auckland School of Medicine, Auckland University, Auckland, New Zealand.

Correspondence to: Dr F McQueen, Department of Molecular Medicine, Auckland School of Medicine, Auckland University, Private Bag 92019, Auckland, New Zealand.

Accepted for publication 9 December 1998

OBJECTIVESTo investigate the progression of joint damage in early rheumatoid arthritis (RA) using magnetic resonance imaging (MRI) of the wrist and determine whether this technique can be used to predict prognosis.
METHODSAn inception cohort of 42 early patients has been followed up prospectively for one year. Gadolinium enhanced MRI scans of the dominant wrist were obtained at baseline and one year and scored for synovitis, tendonitis, bone marrow oedema, and erosions. Plain radiographs were performed concurrently and scored for erosions. Patients were assessed clinically for disease activity and HLA-DRB1 genotyping was performed.
RESULTSAt one year, MRI erosions were found in 74% of patients (31 of 42) compared with 45% at baseline. Twelve patients (28.6%) had radiographic erosions at one year. The total MRI score and MRI erosion score increased significantly from baseline to one year despite falls in clinical measures of inflammation including erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and swollen joint count (p < 0.01 for all). Baseline findings that predicted carpal MRI erosions at one year included a total MRI score of 6 or greater (sensitivity: 93.3%, specificity 81.8%, positive predictive value 93.3%, p = 0.000007), MRI bone oedema (OR = 6.47, p < 0.001), MRI synovitis (OR = 2.14, p = 0.003), and pain score (p = 0.01). Radiological erosions at one year were predicted by a total MRI score at baseline of greater than 13 (OR = 12.4, p = 0.002), the presence of MRI erosions (OR = 11.6, p = 0.005), and the ESR (p = 0.02). If MRI erosions were absent at baseline and the total MRI score was low, radiological erosions were highly unlikely to develop by one year (negative predictive value 0.91 and 0.92 respectively). No association was found between the shared epitope and erosions on MRI (p = 0.4) or radiography (p = 1.0) at one year.
CONCLUSIONSMRI scans of the dominant wrist are useful in predicting MRI and radiological erosions in early RA and may indicate the patients that should be managed aggressively. Discordance has been demonstrated between clinical improvement and progression of MRI erosion scores.

Keywords: magnetic resonance imaging; carpus; rheumatoid arthritis; prognosis

---

© 1999 by Annals of the Rheumatic Diseases
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Naraghi, A. M., White, L. M., Patel, C., Tomlinson, G., Keystone, E. C. (2009). Comparison of 1.0-T Extremity MR and 1.5-T Conventional High-Field-Strength MR in Patients with Rheumatoid Arthritis. Radiology 251: 829-837 [Abstract] [Full Text]  
• Hetland, M L, Ejbjerg, B, Horslev-Petersen, K, Jacobsen, S, Vestergaard, A, Jurik, A G, Stengaard-Pedersen, K, Junker, P, Lottenburger, T, Hansen, I, Andersen, L S, Tarp, U, Skjodt, H, Pedersen, J K, Majgaard, O, Svendsen, A J, Ellingsen, T, Lindegaard, H, Christensen, A F, Vallo, J, Torfing, T, Narvestad, E, Thomsen, H S, Ostergaard, M, and the CIMESTRA study group, (2009). MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA). Ann Rheum Dis 68: 384-390 [Abstract] [Full Text]  
• McQueen, F. M. (2008). The use of MRI in early RA. Rheumatology (Oxford) 47: 1597-1599 [Full Text]  
• Karonitsch, T, Aletaha, D, Boers, M, Bombardieri, S, Combe, B, Dougados, M, Emery, P, Felson, D, Gomez-Reino, J, Keystone, E, Kvien, T K, Martin-Mola, E, Matucci-Cerinic, M, Richards, P, van Riel, P, Siegel, J, Smolen, J S, Sokka, T, van der Heijde, D, van Vollenhoven, R, Ward, M, Wells, G, Zink, A, Landewe, R (2008). Methods of deriving EULAR/ACR recommendations on reporting disease activity in clinical trials of patients with rheumatoid arthritis. Ann Rheum Dis 67: 1365-1373 [Abstract] [Full Text]  
• Adams, J., Burridge, J., Mullee, M., Hammond, A., Cooper, C. (2008). The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial. Rheumatology (Oxford) 47: 1548-1553 [Abstract] [Full Text]  
• Haavardsholm, E A, Boyesen, P, Ostergaard, M, Schildvold, A, Kvien, T K (2008). Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression. Ann Rheum Dis 67: 794-800 [Abstract] [Full Text]  
• Kamijo, S., Nakajima, A., Kamata, K., Kurosawa, H., Yagita, H., Okumura, K. (2008). Involvement of TWEAK/Fn14 interaction in the synovial inflammation of RA. Rheumatology (Oxford) 47: 442-450 [Abstract] [Full Text]  
• McQueen, F M (2007). A vital clue to deciphering bone pathology: MRI bone oedema in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 66: 1549-1552 [Full Text]  
• Symmons, D. P. M. (2007). Classification criteria for rheumatoid arthritis--time to abandon rheumatoid factor?. Rheumatology (Oxford) 46: 725-726 [Full Text]  
• Palosaari, K., Vuotila, J., Takalo, R., Jartti, A., Niemela, R. K., Karjalainen, A., Haapea, M., Soini, I., Tervonen, O., Hakala, M. (2006). Bone oedema predicts erosive progression on wrist MRI in early RA--a 2-yr observational MRI and NC scintigraphy study. Rheumatology (Oxford) 45: 1542-1548 [Abstract] [Full Text]  
• Kamata, K., Kamijo, S., Nakajima, A., Koyanagi, A., Kurosawa, H., Yagita, H., Okumura, K. (2006). Involvement of TNF-Like Weak Inducer of Apoptosis in the Pathogenesis of Collagen-Induced Arthritis. J. Immunol. 177: 6433-6439 [Abstract] [Full Text]  
• Lindegaard, H M, Vallo, J, Horslev-Petersen, K, Junker, P, Ostergaard, M (2006). Low-cost, low-field dedicated extremity magnetic resonance imaging in early rheumatoid arthritis: a 1-year follow-up study. Ann Rheum Dis 65: 1208-1212 [Abstract] [Full Text]  
• Yao, L., Magalnick, M., Wilson, M., Lipsky, P., Goldbach-Mansky, R. (2006). Periarticular bone findings in rheumatoid arthritis: T2-weighted versus contrast-enhanced T1-weighted MRI.. Am. J. Roentgenol. 187: 358-363 [Abstract] [Full Text]  
• Scheel, A K, Hermann, K-G A, Ohrndorf, S, Werner, C, Schirmer, C, Detert, J, Bollow, M, Hamm, B, Muller, G A, Burmester, G R, Backhaus, M (2006). Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis 65: 595-600 [Abstract] [Full Text]  
• Zheng, S, Robinson, E, Yeoman, S, Stewart, N, Crabbe, J, Rouse, J, McQueen, F M (2006). MRI bone oedema predicts eight year tendon function at the wrist but not the requirement for orthopaedic surgery in rheumatoid arthritis. Ann Rheum Dis 65: 607-611 [Abstract] [Full Text]  
• Sommer, O. J., Kladosek, A., Weiler, V., Czembirek, H., Boeck, M., Stiskal, M. (2005). Rheumatoid Arthritis: A Practical Guide to State-of-the-Art Imaging, Image Interpretation, and Clinical Implications. RadioGraphics 25: 381-398 [Abstract] [Full Text]  
• Palosaari, K., Vuotila, J., Takalo, R., Jartti, A., Niemela, R., Haapea, M., Soini, I., Tervonen, O., Hakala, M. (2004). Contrast-enhanced dynamic and static MRI correlates with quantitative 99Tcm-labelled nanocolloid scintigraphy. Study of early rheumatoid arthritis patients. Rheumatology (Oxford) 43: 1364-1373 [Abstract] [Full Text]  
• Majeed, M, McQueen, F, Yeoman, S, McLean, L (2004). Relationship between serum hyaluronic acid level and disease activity in early rheumatoid arthritis. Ann Rheum Dis 63: 1166-1168 [Abstract] [Full Text]  
• Boutry, N., Larde, A., Demondion, X., Cortet, B., Cotten, H., Cotten, A. (2004). Metacarpophalangeal Joints at US in Asymptomatic Volunteers and Cadaveric Specimens. Radiology 232: 716-724 [Abstract] [Full Text]  
• Peterfy, C G (2004). MRI of the wrist in early rheumatoid arthritis. Ann Rheum Dis 63: 473-477 [Full Text]  
• Benton, N, Stewart, N, Crabbe, J, Robinson, E, Yeoman, S, McQueen, F M (2004). MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann Rheum Dis 63: 555-561 [Abstract] [Full Text]  
• Taouli, B., Zaim, S., Peterfy, C. G., Lynch, J. A., Stork, A., Guermazi, A., Fan, B., Fye, K. H., Genant, H. K. (2004). Rheumatoid Arthritis of the Hand and Wrist: Comparison of Three Imaging Techniques. Am. J. Roentgenol. 182: 937-943 [Abstract] [Full Text]  
• Pokorny, V, Chau, J, Wu, L, Yeoman, S, Black, P, McQueen, F, McLean, L (2003). Transforming growth factor {beta}1 gene (HSTGFB1) nucleotide T869C (codon 10) polymorphism is not associated with prevalence or severity of rheumatoid arthritis in a Caucasian population. Ann Rheum Dis 62: 907-908 [Full Text]  
• Ory, P A (2003). Interpreting radiographic data in rheumatoid arthritis. Ann Rheum Dis 62: 597-604 [Abstract] [Full Text]  
• Corr, M., Crain, B. (2002). The Role of Fc{gamma}R Signaling in the K/B x N Serum Transfer Model of Arthritis. J. Immunol. 169: 6604-6609 [Abstract] [Full Text]  
• Taouli, B, Guermazi, A, Sack, K E, Genant, H K (2002). Imaging of the hand and wrist in RA. Ann Rheum Dis 61: 867-869 [Full Text]  
• Backhaus, M, Burmester, G R, Sandrock, D, Loreck, D, Hess, D, Scholz, A, Blind, S, Hamm, B, Bollow, M (2002). Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 61: 895-904 [Abstract] [Full Text]  
• Bryl, E., Vallejo, A. N., Weyand, C. M., Goronzy, J. J. (2001). Down-Regulation of CD28 Expression by TNF-{alpha}. J. Immunol. 167: 3231-3238 [Abstract] [Full Text]  
• McQueen, F M, Benton, N, Crabbe, J, Robinson, E, Yeoman, S, McLean, L, Stewart, N (2001). What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using x rays and magnetic resonance imaging over the first two years of disease. Ann Rheum Dis 60: 859-868 [Abstract] [Full Text]  
• Lindegaard, H, Vallo, J, Horslev-Petersen, K, Junker, P, Ostergaard, M (2001). Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset. Ann Rheum Dis 60: 770-776 [Abstract] [Full Text]  
• Ostergaard, M, Ejbjerg, B, Stoltenberg, M, Gideon, P, Volck, B, Skov, K, Jensen, C H., Lorenzen, I (2001). Quantitative magnetic resonance imaging as marker of synovial membrane regeneration and recurrence of synovitis after arthroscopic knee joint synovectomy: a one year follow up study. Ann Rheum Dis 60: 233-236 [Abstract] [Full Text]  
• Klarlund, M, Østergaard, M, Jensen, K E, Madsen, J L., Skjødt, H, Lorenzen, I, the TIRA group, (2000). Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. Ann Rheum Dis 59: 521-528 [Abstract] [Full Text]  
• McQueen, F. M. (2000). Magnetic resonance imaging in early inflammatory arthritis: what is its role?. Rheumatology (Oxford) 39: 700-706 [Abstract] [Full Text]  
• Huang, J., Stewart, N., Crabbe, J., Robinson, E., McLean, L., Yeoman, S., Tan, P. L. J., McQueen, F. M. (2000). A 1-year follow-up study of dynamic magnetic resonance imaging in early rheumatoid arthritis reveals synovitis to be increased in shared epitope-positive patients and predictive of erosions at 1 year. Rheumatology (Oxford) 39: 407-416 [Abstract] [Full Text]