Background When diagnosing inflammatory arthritis (IA) early, focal joint imaging may not reflect the overall inflammatory burden/distribution. Whole body MRI (WBMRI) offers the potential to feasibly scan most joints in a single session.
Objectives The aims were (i) to describe the WBMRI pattern of disease in early IA (ii) to identify patterns associated with subsequent definite IA.
Methods Patients were recruited with early inflammatory joint symptoms and/or signs of IA. Clinical data included age, gender, symptom duration, CRP, HLA-B27, RF, CCP Ab and tender/swollen joint counts. Using 3T WBMRI, T2-weighted fat suppressed spine/SIJ images pre contrast and 3D VIBE Dixon images of peripheral joints and entheses post IV contrast were acquired. Images were consensus scored for inflammation/erosion at the spine, SIJ, GHJ, SCJ, wrist, MCP, PIP, hip, knee, ankle, mid/hind foot, MTP and IP joints plus shoulder, ASIS, greater trochanter, knee, Achilles and plantar fascia entheses. Subjects were clinically classified at baseline and 1 year as undifferentiated arthritis (UA), CCP+RA, CCP-RA or Spondyloarthropathy (SpA). Clinicians were unaware of the MRI findings.
Results 39 patients (23 female) were recruited; mean age 43 years, median symptom duration 18 months (7, 24), TJC 5 (2,11), SJC 1 (0,3) and CRP 2 (2,2). At baseline, 14 were classified as definite disease (RA or SpA) and 25 (14 female) as UA with mean age 40 years, median symptom duration 16.5 months (9.8, 24.3), TJC 3 (1,8), SJC 0 (0,1), CRP 2 (2,2) and 3 (12%) were HLA-B27 positive. The distribution of WBMRI findings in the classified (i.e. definite IA) group was predominantly small joint and tendon-based in the CCP+ RA group, large joint based with 50% having SIJ disease in the CCP- group and similar findings in the SpA group. In the non-classified group (i.e. pUA and rUA), the distribution in pUA was both axial and peripheral, involving joints and entheses, with 25% having SIJ disease. In comparison, findings in the rUA group were similarly distributed but less frequent with no cases of SIJ disease. After 1 year of clinical/laboratory follow-up, 8 were identified as pUA, 6 rUA, 7 CCP+RA, 6 CCP-RA and 12 as SpA. Table 1 shows WBMRI disease distribution by 1 year diagnostic category. The inclusion of affected WBMRI sites in the diagnostic work-up would have appropriately classified 6 further cases of definite SpA, 3 from the pUA and 3 from the CCP-RA groups.
Conclusions In the persistent UA group and CCP-RA group, WBMRI findings at baseline already showed a definite pattern of spinal disease. Therefore the use of WBMRI findings at presentation in addition to clinical assessment would allow clinicians to classify a proportion of patients earlier.
Disclosure of Interest None declared