Background Qualitative MRI assessment of hand inflammation in scleroderma (SSc) has been reported in only few MRI studies. However, there are no studies with quantitative assessment and differentiation of arthritis in SSc from other arthritides
Objectives To compare low field MRI features- synovitis, bone marrow oedema (BME) and bone erosions, among patients with inflammatory hand pain in rheumatoid arthritis (RA) and systemic sclerosis (SSc).
Methods 35 RA (EULAR/ACR 2010 criteria) and 82 SSc pts with clinical involvement of hand joints were consecutively included in the study. The 0.2T extremity contrast MRI was performed on the wrist and MCP joints of the more painful hand in all the pts. The inflammatory changes (synovitis, BME and bone erosions) were scored by two independent musculoskeletal radiologists who followed the recommendations of the OMERACT RAMRIS. Total scores were compared between SSc and RA groups of patients.
Results 35 RA pts (mean age 54.3) and 82 SSc patients (mean age 54.5) with painful hands underwent 0.2T extremity MRI. Rheumatoid factor (RF) and anti-ciltrullinated protein antibodies (ACPA) were found in 74.3% and 89% RA pts, respectively, and in 14.6% and 13.4% SSc pts. Higher frequency of synovitis with statistically higher MRI score was observed in RA compared to SSc pts (wrist: 4.37±1.31 vs. 2.69±2.29, p<0.001; MCP joints: 5.26±2.09 vs. 3.15±2.95, p<0.001). MRI erosions scored on the wrist and MCP joints were statistically higher in RA pts compared to SSc pts (wrist: 20.57±10.23 vs. 6.58±10.89, p<0,001; MCP joints: 10.51±7.90 vs. 3.99±9.82, p<0.001). MRI BME scores were, also, statistically higher in RA pts compared to SSc on the wrist (18.60±5.01 vs. 6.84±7.43, p<0.001) and on MCP joints (9.09±4.27 vs. 4.04±4.76, p<0.001)
Conclusions Our results suggest that painful hand in RA and SSc pts is associated with inflammatory changes on MRI: synovitis, erosions and bone marrow oedema. MRI scores of inflammation are much higher in RA than in SSc pts. MRI might help the physician to differentiate RA and SSc in pts with painful hand.
Disclosure of Interest None Declared