Adult Inflammatory Arthritides: What the Radiologist Should Know

Abstract

Developments and improvements in knowledge are rapid and ongoing in both the radiologic and rheumatologic fields. During the past decade, the roles of imaging and the radiologist in the assessment and management of many inflammatory rheumatologic diseases have undergone several changes. To remain effective in patient care, the radiologist needs to be aware of these changes when recommending and interpreting imaging examinations for the referring physician. The goal of contemporary rheumatoid arthritis (RA) management is to redefine RA as a disease that is no longer characterized by erosions, which reflect established or long-standing untreated disease. Most cases of RA are now diagnosed clinically, but imaging increases diagnostic confidence, is superior to clinical examination for the detection of joint inflammation, and plays an important role in patient management. The concept of the seronegative spondyloarthritides has recently been redefined by the Assessment of SpondyloArthritis International Society (ASAS). This new set of ASAS classification criteria divides the spectrum of spondyloarthritis on the basis of predominantly axial skeletal clinical manifestations or predominantly peripheral skeletal clinical manifestations. For axial spondyloarthritis, magnetic resonance imaging and radiography play crucial roles for classification and diagnosis. For both peripheral spondyloarthritis and psoriatic arthritis, the radiologist can provide important information that influences classification and diagnosis, including documenting radiologic evidence of juxta-articular new bone formation, diagnosing sacroiliitis, or delineating the presence and extent of enthesitis and dactylitis. The radiologist's familiarity with recent classification criteria, in addition to the traditional diagnostic characteristics of the individual inflammatory arthritides, maximizes the productive interface between the radiologist and the rheumatologist. RSNA, 2016.

Case series: Monoarticular rheumatoid arthritis

“…This leads to the question of whether further adjustment to the 2010 ACR criteria is needed, as proposed by Van der Ven et al (12), to identify more early RA patients in whom early treatment could result in improved patient outcomes. The 2010 ACR criteria do not include a radiological domain despite the presence of well-established data indicating that imaging can show evidence of disease as well as mounting data suggesting that advances in imaging techniques can help predict and uncover early RA (13)(14)(15)(16). Based on our case series, any imaging study such as an x-ray showing marginal erosive changes or advanced imaging such as magnetic resonance imaging or high-power Doppler ultrasound can confirm the diagnosis of RA.…”

Magnetic resonance imaging of rheumatological diseases

“…Although fluid and synovium may have similar signal intensities on unenhanced MRI, complex (non-simple fluid) fluid collections, synovial thickening, and chronic synovial proliferation can still often be differentiated on unenhanced imaging studies, because they often show lower signal intensity on fluid-sensitive sequences than simple fluid [4]. Intravenous administration of gadolinium-based contrast media allows for easier differentiation between active synovitis, simple effusions, and complex effusions [4,5]. T1W images should be obtained before and after the intravenous administration of contrast; these images are usually obtained with fat saturation to improve visualization of contrast enhancement.…”

“…extending laterally to include the paravertebral synovial joints [4]. As with the sacroiliac joints, contrast-enhanced imaging and DWI of the spine may be obtained as needed.…”

“…It affects 1% of the world's population; women are affected 2 to 3 times more than men [9][10][11]14,16,26]. This disease has a peak age of onset between 45 and 65 years [10,11] and has both genetic and environmental risk factors [4,11,25,26]. The main symptoms of RA are joint pain, stiffness, and impaired function.…”

Rheumatoid arthritis classification criteria: debatable problems

“…• снижения суммы необходимых для диагноза РА баллов с 6 до 5 [13], что, с одной стороны, позволит идентифицировать на 15% больше больных ранним РА, но, с другой стороны, на 8% увеличится число ложноположительных диагнозов РА. • включения современных инструментальных методов, которые могут помочь в диагностике раннего РА [14][15][16][17], что представляется более логичным и обосновывается данными недавно опубликованного обзора [18], подтвердившими потенциальные возможности применения УЗИ суставов в диагностике больных с ранним воспалительным артритом до развития РА и на его ранней стадии, когда мышечно-скелетные симптомы не сопровождаются клинически определяемым синовитом [19].…”