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Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints

A K Scheel^1,*, K-G A Hermann^2,*, S Ohrndorf¹, C Werner³, C Schirmer², J Detert⁴, M Bollow⁵, B Hamm², G A Müller¹, G R Burmester⁴, M Backhaus⁴

¹ Department of Medicine, Nephrology and Rheumatology, Georg-August-University Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
² Department of Radiology, Charité University Hospital, Schumannstrasse 20/21, D-10098 Berlin, Germany
³ Department of Medical Statistics, Georg-August-University Göttingen, Humboldtallee 32, D-37073 Göttingen, Germany
⁴ Department of Medicine, Rheumatology and Clinical Immunology, Charité University Hospital, Schumannstrassse 20/21, D-10098 Berlin, Germany
⁵ Department of Radiology, Augusta Hospital, Bergstrasse 26, D-44791 Bochum, Germany

Correspondence to:
Dr A K Scheel
Department of Medicine, Nephrology and Rheumatology, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany; ascheel{at}gwdg.de

Objective: To perform a prospective long term follow up study comparing conventional radiography (CR), ultrasonography (US), and magnetic resonance imaging (MRI) in the detection of bone erosions and synovitis in rheumatoid arthritis (RA) finger joints.

Methods: The metacarpophalangeal and proximal interphalangeal joints II–V (128 joints) of the clinically dominant hand of 16 patients with RA were included. Follow up joint by joint comparisons for erosions and synovitis were made.

Results: At baseline, CR detected erosions in 5/128 (4%) of all joints, US in 12/128 (9%), and MRI in 34/128 (27%). Seven years later, an increase of joints with erosions was found with CR (26%), US (49%) (p<0.001 each), and MRI (32%, NS). In contrast, joint swelling and tenderness assessed by clinical examination were decreased at follow up (p = 0.2, p<0.001). A significant reduction in synovitis with US and MRI (p<0.001 each) was seen. In CR, 12 patients did not have any erosions at baseline, while in 10/12 patients erosions were detected in 25/96 (26%) joints after 7 years. US initially detected erosions in 9 joints, of which two of these joints with erosions were seen by CR at follow up. MRI initially found 34 erosions, of which 14 (41%) were then detected by CR.

Conclusion: After 7 years, an increase of bone erosions was detected by all imaging modalities. In contrast, clinical improvement and regression of synovitis were seen only with US and MRI. More than one third of erosions previously detected by MRI were seen by CR 7 years later.

Abbreviations: CE, clinical examination; CR, conventional radiography; CRP, C reactive protein; DMARDs, disease modifying antirheumatic drugs; ESR, erythrocyte sedimentation rate; MCP, metacarpophalangeal; MRI, magnetic resonance imaging; OMERACT, Outcome Measures in Rheumatology (working group); PIP, proximal interphalangeal; RA, rheumatoid arthritis; US, ultrasonography

Keywords: ultrasonography; magnetic resonance imaging; radiography; rheumatoid arthritis; finger joints

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