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The use of MRI-detected synovitis to determine the number of involved joints for the 2010 ACR/EULAR classification criteria for Rheumatoid Arthritis – is it of additional benefit?
  1. Aleid C Boer1,
  2. Debbie M Boeters1,
  3. Annette H M van der Helm-van Mil1,2
  1. 1 Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
  2. 2 Department of Rheumatology, Erasmus Medical Centre, Leiden, The Netherlands
  1. Correspondence to Aleid C Boer, Department of Rheumatology, Leiden University Medical Centre, Leiden 2300 RC, The Netherlands; a.c.boer{at}


Objective To assess the value of MRI-detected synovitis to determine the number of involved joints on the performance of the 2010-ACR/EULAR classification criteria for rheumatoid arthritis (RA).

Methods 277 patients with a clinical suspicion of RA consecutively included in the Leiden Early Arthritis Clinic (EAC)-cohort underwent 1.5T MRI of MCP-, wrist- and MTP-joints. Test characteristics of the 2010-criteria were calculated when the number of involved joints was determined with and without including MRI-detected synovitis. Two outcomes were studied: disease modifying anti-rheumatic drug (DMARD)-initiation and 1987-criteria fulfilment during the first year.

Results At baseline, 143 patients were classified as RA. When MRI-detected synovitis was considered, 14 patients additionally fulfilled the 2010-criteria. Of these, 64% (9/14) started DMARDs. When MRI-detected synovitis was also used to determine the number of involved joints the sensitivity changed from 62% to 67%, the specificity from 90% to 84% and the AUC from 0.76 to 0.75. The net reclassification index was −2.4%. When fulfilling the 1987-criteria was used as outcome, results were similar.

Conclusion We found no scientific support that the use of MRI-detected synovitis is of additional benefit for the performance of the 2010 classification criteria.

  • rheumatoid arthritis
  • early rheumatoid arthritis
  • magnetic resonance imaging

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  • Handling editor Josef S Smolen

  • Contributors ACB, DB and AHMvdHvM made a substantial contribution to the acquisition, analysis and interpretation of the data. All authors made a substantial contribution to the conception and design of the work. ACB and AHMvdHvM drafted the manuscript; DB revised the manuscript critically for important intellectual content. All authors approved the final version of the manuscript.

  • Funding The research leading to these results has received funding from a Vidi-grant of the Netherlands Organization for Health Research and Development and from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Starting grant, agreement No 714312). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval ’Commissie Medische Ethiek' of the Leiden University Medical Centre.

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