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a The Danish Research
Centre of Magnetic Resonance, H:S Hvidovre Hospital, University of
Copenhagen, b Department Internal Medicine, Division of
Rheumatology, H:S Hvidovre Hospital, c Department of Radiology, H:S Hvidovre Hospital, d Department
of Clinical Physiology and Nuclear Medicine, H:S Hvidovre Hospital
Correspondence to: Dr Mette Klarlund, Department of Internal Medicine, Division of Rheumatology, H:S Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark Email: klarlund{at}dadlnet.dk
Accepted for publication 3 February 2000
OBJECTIVES
To
evaluate synovial membrane hypertrophy, tenosynovitis, and erosion
development of the 2nd to 5th metacarpophalangeal (MCP) and proximal
interphalangeal (PIP) joints by magnetic resonance imaging in a group
of patients with rheumatoid arthritis (RA) or suspected RA followed up
for one year. Additionally, to compare the results with radiography,
bone scintigraphy, and clinical findings.
PATIENTS AND
METHODSFifty five
patients were examined at baseline, of whom 34 were followed up for one
year. Twenty one patients already fulfilled the American College of
Rheumatology (ACR) criteria for RA at baseline, five fulfilled the
criteria only after one year's follow up, whereas eight maintained the
original diagnosis of early unclassified polyarthritis. The following
MRI variables were assessed at baseline and one year: synovial membrane
hypertrophy score, number of erosions, and tenosynovitis score.
RESULTSMRI
detected progression of erosions earlier and more often than did
radiography of the same joints; at baseline the MRI to radiography
ratio was 28:4. Erosions were exclusively found in patients with RA at
baseline or fulfilling the ACR criteria at one year. At one year follow
up, scores of MR synovial membrane hypertrophy, tenosynovitis, and
scintigraphic tracer accumulation had not changed significantly from
baseline; in contrast, swollen and tender joint counts had declined
significantly (p<0.05).
CONCLUSIONSMRI
detected more erosions than radiography. MR synovial membrane
hypertrophy and scintigraphy scores did not parallel the changes seen
over time in clinically assessed swollen and tender joint counts.
Although joint disease activity may be assessed as quiescent by
conventional clinical methods, a more detailed evaluation by MRI may
show that a pathological condition is still present within the synovium.
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