Prospective long term follow-up imaging study comparing radiography, ultrasonography and magnetic resonance imaging in rheumatoid arthritis finger joints

Alexander K Scheel ^1*, Kay-Geert A Hermann ², Sarah Ohrndorf ¹, Carola Werner ³, Claudia Schirmer ², Jacqueline Detert ⁴, Matthias Bollow ⁵, Bernd Hamm ², Gerhard A Müller ¹, Gerd R Burmester ⁴ and Marina Backhaus ⁴

¹ Nephrology and Rheumatology, Georg-August-University Göttingen, Germany
² Radiology, Charité University Medicine, Germany
³ Medical Statistics, Georg-August-University Göttingen, Germany
⁴ Rheumatology and clinical Immunology, Charité University Medicine, Germany
⁵ Radiology, Bochum, Germany

^* To whom correspondence should be addressed. E-mail: ascheel{at}gwdg.de.

Accepted 26 September 2005

Abstract

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 RA patients were included. Follow-up comparisons for erosions and synovitis were performed in a joint by joint manner.

Results: At baseline, CR detected erosions in 4% of all joints, US in 9% and MRI in 27%. Seven years later, an increase of joints with erosions was found with CR (26%), US (49%) (p<0.001 each) and MRI (32%, n.s.). In contrast, joint swelling and tenderness assessed by clinical examination showed a decrease at follow-up (p=0.2, p<0.001). We saw a significant reduction in synovitis with US and MRI (p<0.001 each). In CR, 12 patients did not have any erosions at baseline, while in 10 of the 12 patients erosions were detected in 25 of the 96 joints (26%) after 7 years. US initially detected erosions in 9 joints (7%), of which 2 joints with erosions were seen in CR at follow-up. MRI initially found 34 erosions, out of which 14 (41%) were then detected in CR.

Conclusion: After 7 years, an increase of bone erosions was detected by all imaging modalities. In contrast, we saw clinical improvement and a regression of synovitis with US and MRI. More than one third of erosions previously detected by MRI presented on CR seven years later.

Keywords: MRI, finger joint, follow-up, rheumatoid arthritis, ultrasonography

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