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Evaluation of the predictive accuracy of MRI-detected erosions in hand and foot joints in patients with undifferentiated arthritis
  1. Debbie M Boeters1,
  2. Aleid C Boer1,
  3. Annette H M van der Helm-van Mil1,2
  1. 1 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Debbie M Boeters, Department of Rheumatology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands; D.M.Boeters{at}

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Radiographic erosions are a clear hallmark of rheumatoid arthritis (RA). The European League Against Rheumatism (EULAR) definition of radiographic erosive disease has a high specificity, and its fulfilment alone is sufficient to classify RA.1 However, the sensitivity of radiography to detect erosions early in the disease is low. Other imaging techniques, such as MRI, are more sensitive to detect erosions than radiography and are therefore recommended by a EULAR imaging task force.2 To determine the specificity of MRI-detected erosions, we recently compared erosions in the metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints (scored according to the RA MRI Scoring System (RAMRIS)3) of patients presenting with RA with those of symptom-free persons and patients presenting with arthritides other than RA.4 MRI-detected erosions were present in all groups; therefore, the specificity of the presence of any MRI-detected erosions was low. By evaluating different erosion features, a few features were identified as specific for RA; these were severe erosions (grade ≥2, defined as >10% of bone eroded), erosions in MTP5 and erosions in MTP1 in persons aged <40. A subsequent and clinically relevant question is whether MRI-detected erosions in patients presenting with undifferentiated arthritis (UA) are valuable in predicting future progression to RA. This was explored to a limited extent in our previous study but as the number of patients with UA was limited (n=192), the predictive value of the different ‘RA-specific …

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  • Contributors DMB and AHMvdHvM contributed to the conception and study design. DMB and ACB contributed to the acquisition of the data. DMB analysed the data. DMB and AHMvdHvM wrote the first version of the manuscript and ACB revised it critically. All authors read and approved the final manuscript.

  • Funding This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Starting grant, agreement no. 714312).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Local Medical Ethics Committee, which is named ‘Commissie Medische Ethiek’.

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

  • Data sharing statement Data can be requested from the corresponding author.

  • Correction notice This article has been corrected since it published Online First. The title of table 1 has been corrected.