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Extended report
Assessment of cartilage loss at the wrist in rheumatoid arthritis using a new MRI scoring system
  1. Fiona McQueen1,3,
  2. Andrew Clarke2,
  3. Alex McHaffie2,
  4. Quentin Reeves2,5,
  5. Megan Williams3,
  6. Elizabeth Robinson4,
  7. Jing Dong1,
  8. Arista Chand1,
  9. Desiree Mulders5,
  10. Nicola Dalbeth3,6
  1. 1Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
  2. 2Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
  3. 3Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
  4. 4Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
  5. 5Specialist Radiology and MRI Ltd, Ascot Office Park, Auckland, New Zealand
  6. 6Department of Medicine, University of Auckland, Auckland, New Zealand
  1. Correspondence to Professor Fiona McQueen, Department of Molecular Medicine and Pathology, Auckland School of Medicine, University of Auckland, 85 Park Road, Grafton, Auckland, 92019, New Zealand; f.mcqueen{at}


Objectives To develop and test an MRI cartilage scoring system for use at the wrist in rheumatoid arthritis (RA).

Methods MRI scans were obtained using a 3T MRI scanner with dedicated wrist coil in 22 early and 16 established RA patients plus 22 controls. Axial and coronal T1-weighted (precontrast and postcontrast) and T2-weighted turbo spin echo sequences were obtained. Eight wrist joints were scored for cartilage narrowing: distal radioulnar, radiolunate, radioscaphoid, triquetrum-hamate, capitate-lunate, scaphotrapezoid, second metacarpal base-trapezoid and third metacarpal base-capitate, using a system based on the Sharp van der Heijde x-ray joint space narrowing (JSN) score by three radiologists. Fifteen sites at the wrist were also scored for synovitis, bone oedema and erosion using the RA MRI score.

Results Interobserver (three-reader) and intraobserver reliability (readers 1 and 2) for the cartilage score were excellent: intraclass correlations (ICC (95% CI)) 0.91, (0.86 to 0.94), 0.98 (0.96 to 1.00) and 0.94 (0.87 to 1.00), respectively. Cartilage scores (median, range) were higher in the established RA group (11.9, 2.3–27.3) than the early RA group (2.15, 0–6) (p≤0.001) but early RA scores did not differ from healthy controls (2.3, 1–8.7). Cartilage scores correlated with synovitis (R=0.52), bone oedema (R=0.63) and erosion scores (R=0.66), p<0.001 for all, and with x-ray JSN scores (R=0.68 to 0.78).

Conclusion This MRI cartilage score demonstrated excellent reliability when tested in a three-reader system. However, cartilage loss in early RA could not be distinguished from that seen in healthy controls.

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  • Funding This work was supported by grants from the Auckland Medical Research Foundation, the Auckland Regional Rheumatology Research Trust and the University of Auckland (funded studentship for JD).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the New Zealand Multiregion Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.