Low-cost, low-field dedicated extremity magnetic resonance imaging in early rheumatoid arthritis: a 1-year follow-up study
- 1Department of Internal Medicine C, Section of Rheumatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- 2Department of Radiology, Aabenraa Hospital, Aabenraa, Denmark
- 3Department of Rheumatology, Graasten Gigthospital, Graasten, Denmark
- 4The Danish Research Centre of Magnetic Resonance, Department of Rheumatology, Copenhagen University Hospitals at Hvidovre and Herlev, University of Copenhagen, Copenhagen, Denmark
- Correspondence to:
H M Lindegaard
Department of Internal Medicine C, Section of Rheumatology, Odense University Hospital, Søndre Boulevard 29, Dk-5000 Odense C, Denmark;
- Accepted 2 March 2006
- Published Online First 15 March 2006
Objective: To study the ability of low-cost low-field dedicated extremity magnetic resonance imaging (E-MRI) to assess and predict erosive joint damage in the wrist and metacarpophalangeal (MCP) joints of patients with early rheumatoid arthritis.
Methods: 24 previously untreated patients with rheumatoid arthritis with joint symptoms for <1 year were evaluated at the time of diagnosis and after 6 and 12 months of methotrexate treatment with conventional clinical or biochemical examinations, x rays of both hands and wrists, and E-MRI of the dominant wrist and MCP joints.
Results: At baseline, all patients showed magnetic resonance imaging (MRI) synovitis, and MRI erosions were detected in 21 bones (10 patients). 6 (29%) of these, distributed among two patients, were seen on x ray. One x ray erosion was not detected by MRI. At 1 year, MRI and x ray detected 15 and 8 new erosions, respectively, and 19% of MRI erosions at baseline had progressed to x ray erosions. In bones with MRI erosions at baseline, the relative risk of having x ray erosions at the 1-year follow-up was 12.1, compared with bones without baseline MRI erosions (lesion-centred analysis). If bones with baseline x ray erosions were excluded, the relative risk was 5.2. In patients with baseline MRI bone erosion or oedema, the relative risk of having x ray erosions at 1 year was 4.0, compared with patients without these signs at baseline (patient-centred analysis).
Conclusion: In this group of patients with early rheumatoid arthritis who were treated uniformly, baseline E-MRI erosions in MCP or wrist bones markedly increased the risk of x ray erosions at the 1-year follow-up. Low-cost, low-field dedicated extremity MRI is promising for assessment and prognostication of early rheumatoid arthritis.
- CRP, C reactive protein
- DMARD, disease-modifying antirheumatic drug
- E-MRI, extremity magnetic resonance imaging
- ESR, erythrocyte sedimentation rate
- FOV, field of view
- IQR, interquartile range
- MCP, metacarpophalangeal
- MRI, magnetic resonance imaging
- OMERACT, Outcome Measures in Rheumatology
- STIR, short T1-inversion recovery
Published Online First 15 March 2006
Competing interests: None declared.
Ethical approval: This study was conducted in accordance with the Declaration of Helsinki, and approval was obtained from the local ethics committee before starting the study (J No 19980024).