MRI findings in 84 early rheumatoid arthritis patients: Bone marrow edema predicts erosive progression

Espen A Haavardsholm ^1*, Pernille Bøyesen ¹, Mikkel stergaard ², Arnulf Schildvold ¹ and Tore K Kvien ¹

¹ Diakonhjemmet Hospital, Oslo, Norway
² Depts. of Rheumatology, Copenhagen University Hospitals at Hvidovre and Herlev, Copenhagen, Denmark

^* To whom correspondence should be addressed. E-mail: e.a.haavardsholm{at}medisin.uio.no.

Accepted 22 October 2007

Abstract

Objectives: To examine the spectrum and severity of magnetic resonance imaging (MRI) findings in patients with early rheumatoid arthritis (RA), and to investigate the predictive value of MRI findings for subsequent development of conventional radiographic (CR) damage and MRI erosions.

Methods: We enrolled 84 consecutive RA patients with disease duration <1 year. Patients were treated according to standard clinical practice, and evaluated at baseline, 3, 6 and 12 months by core measures of disease activity, CR of both hands and wrists and MRI of the dominant wrist. MR-images were scored according to the OMERACT RAMRIS scoring system, and CR images according to the van der Heijde modified Sharp score (vdHSS).

Results: MRI findings reflecting inflammation (synovitis, bone marrow edema and tenosynovitis) decreased during follow-up, while there was a small increase in MRI erosion score and CR damage. The proportion of patients with erosive progression at one year was 48% for CR and 66% for MRI. We identified baseline MRI bone marrow edema (score above 2 RAMRIS units) as an independent predictor of both CR (OR 2.77 (95% CI 1.06 - 7.21)) and MRI erosive progression (B 0.21 (95% CI 0.08-0.34)).

Conclusions: MRI findings were frequent in early RA and MRI bone marrow edema was an independent predictor of radiographic damage. These results suggest that MRI scans of the dominant wrist may help clinicians determine which patients need early and aggressive treatment to avoid subsequent joint damage.

Keywords: Magnetic resonance imaging, bone marrow edema, erosion, rheumatoid arthritis, synovitis

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