PREVIOUS DEMAND FOR IMAGING JOINT STRUCTURE

Before the introduction of effective treatment, rheumatology’s demand for imaging joint structure was modest, at best (fig 1). Although it was widely accepted that joint damage was a key driver of functional disability in RA, particularly in late disease,^1–3 without effective treatments to prevent erosive destruction, there was limited need for detailed information about the integrity of joint structure. Magnetic resonance imaging (MRI) promised to tell more about bone erosion, synovitis, and the integrity of cartilage, ligaments and other articular tissues than radiography ever could, but the additional cost and inconveniences associated with MRI were not felt to be worth the extra performance. The information simply did not impact on clinical management. Accordingly, most rheumatologists focused primarily on clinical and laboratory features of the disease, and used imaging only sparingly—if at all. Not surprisingly, the development of MRI for this purpose languished. However, the recent introduction of effective structure modifying treatments has changed the way that rheumatologists manage patients with RA, and this has created new demands on imaging both in clinical practice and in clinical research.