Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset

doi:10.1136/ard.60.8.770

Annals of the Rheumatic Diseases 2001;60:770-776; doi:10.1136/ard.60.8.770

Ann Rheum Dis 2001;60:770-776 ( August )

Extended report

Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset H Lindegaard^a, J Vallø^b, K Hørslev-Petersen^c, P Junker^a, M Østergaard^d

^a Department of Internal Medicine C, Section of Rheumatology, Odense University, Denmark, ^b Department of Radiology, Sønderborg Hospital, ^c Graasten Gigthospital, ^d The Danish Research Centre of Magnetic Resonance, H:S Hvidovre Hospital, University of Copenhagen, Denmark

Correspondence to: Dr H Lindegaard, Department of Internal Medicine, Section of Rheumatology, Odense University Hospital, Søndre Boulevard 29, Dk-5000 Odense C, Denmark lindegaard{at}dadlnet.dk

Accepted for publication 15 November 2000

OBJECTIVE $---$ To compare a low field dedicated extremity magnetic resonance imaging system (E-MRI) with x ray and clinical examination,in the detection of inflammation and erosive lesions in wristand metacarpophalangeal (MCP) joints in newly diagnosed, untreatedrheumatoid arthritis(RA).
PATIENTS AND METHODS $---$ Twenty five patients (disease duration $=<$ 1 year) and three healthy controls entered the study. An x ray examination and MRI(before and after intravenous injection of a contrast agent) ofthe 2nd-5th MCP joints and the wrist was performed. The numberof erosions on x ray examination and MRI was calculated, and synovitisin the MCP joints and wrists was gradedsemiquantitatively.
RESULTS $---$ E-MRI detected 57 bone erosions, whereas only six erosions were disclosed by x ray examination (ratio 9.5:1). Synovial hypertrophygrades were significantly higher in RA joints with clinical signsof joint inflammation $---$ that is, swelling and/or tenderness (median3, 5th-95th centile 1-4) than without these clinical signs (median2, 5th-95th centile 1-3), p<0.001. 51% of the joints without clinicalsigns of synovitis showed synovial hypertrophy on E-MRI. Therewas a positive correlation between MRI scores of synovitis andthe number of erosions detected by MRI in the MCP joints (Spearmanr_s=0.31, p<0.01). No healthy controls had erosions or synovitisonMRI.
CONCLUSION $---$ Joint destruction starts very early in RA and E-MRI allows detailed evaluation of inflammatory and destructive changes inwrists and MCP joints in patients with incipientRA.

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