Arthritis of the finger joints: A comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging

Backhaus, Marina; Kamradt, Thomas; Sandrock, D.; Loreck, D; Fritz, Justine; Wolf, Karl‐Jürgen; Raber, Hans; Hamm, Bernd; Burmester, G.-R.; Bollow, Matthias

doi:10.1002/1529-0131(199906)42:6<1232::aid-anr21>3.0.co;2-3

Cited by 610 publications

(355 citation statements)

References 29 publications

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“…This illustrates that the information on joint destruction provided by CR is associated with a considerable delay. In accordance with results of earlier studies (6)(7)(8)12), we observed that the sensitivity of MRI with respect to visualization of bone erosions was superior to that of CR. Furthermore, MRI detected erosive progression in more bones than did CR (i.e., MRI was more sensitive to change).…”

Section: Discussionsupporting

confidence: 92%

New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier

Østergaard¹,

Hansen²,

Stoltenberg³

et al. 2003

Arthritis & Rheumatism

169

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Objective. In a 5-year followup study, we investigated the temporal relationship between development of wrist joint erosions as visualized by magnetic resonance imaging (MRI) versus conventional radiography (CR), in patients with rheumatoid arthritis. We also evaluated the risk of erosive progression on CR associated with the presence of MRI erosions.Methods. In 10 patients with rheumatoid arthritis, MRI and CR of the dominant wrist were performed annually for 5 years. In each image set, each wrist bone (metacarpal bases, carpal bones, radius, and ulna) was assessed for the absence or presence of bone erosions.Results. Nine bones showed radiographic erosions at baseline. Twenty-seven new radiographic erosions developed during the 5-year followup period. Of these 27 new erosions, 21 were detected 1-5 years earlier by MRI than by CR, 3 were simultaneously detected by both methods, 2 were detected 1-2 years later by MRI than by CR, and 1 erosion (radiographically detected at 5-year followup) was not visualized with MRI. MRI detection of new radiographic erosions preceded CR detection by a median of 2 years. In bones with MRI erosions at baseline, the relative risk of radiographic erosions at 5-year followup was 4.5 (95% confidence interval [95% CI] 2.6-7.6), compared with bones without baseline MRI erosions. If bones with baseline radiographic erosions were excluded from the analysis, the relative risk was 4.1 (95% CI 2.2-7.5).Conclusion. Most new radiographic bone erosions (78%) were visualized at least 1 year earlier by MRI than by CR. This illustrates that the information on joint destruction provided by CR is considerably delayed compared with that provided by MRI. A significantly increased risk of progression of radiographic erosion in bones with baseline MRI erosions was observed, demonstrating a prognostic value of MRI with respect to long-term radiographic outcome.

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Section: Discussionsupporting

confidence: 92%

New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier

Østergaard¹,

Hansen²,

Stoltenberg³

et al. 2003

Arthritis & Rheumatism

169

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“…It is important to emphasize that some features of these definitions, for example, the description of the secondary epiphyseal ossification center in definition 2, do apply to the immature skeleton of a growing child but will not be detectable in the fully ossified bone of an older adolescent. Upon rescoring, a Likert scale score of 4 …”

Section: Resultsmentioning

confidence: 99%

“…Imaging can add important information to the clinical examination in rheumatology, and this is no different in pediatric rheumatology (1)(2)(3)(4)(5)(6). With new treatments, the induction of sustained remission is possible for an increasing percentage of children but cannot always be reliably demonstrated on clinical examination alone (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

“…Among the various imaging modalities, musculoskeletal ultrasonography (MSUS) has been shown to be a reliable, relatively inexpensive, and well-tolerated tool for the precise assessment of disease activity (1,2,4,5). This is also important for long-term outcomes because ongoing, often subclinical disease activity can result in joint damage and structural deterioration (5).…”

Section: Introductionmentioning

confidence: 99%

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Definitions for the Sonographic Features of Joints in Healthy Children

Roth

Jousse‐Joulin

Magni‐Manzoni

et al. 2014

Arthritis Care & Research

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Objective. Musculoskeletal ultrasonography (US) has potential in the assessment of disease activity and structural damage in childhood arthritides. In order to assess pathology, the US characteristics of joints in healthy children need to be defined first. The aim of this study was to develop definitions for the various components of the normal pediatric joint. Methods. The definitions were developed by an expert group and applicability was assessed on a collection of standardized scans of the knee and ankle joints by scoring the scans on a Likert scale. The definitions were then modified and applicability was reassessed before sending the definitions for approval to a larger panel of experts. A final scoring on stored images of all relevant joints at different ages followed. Results. Five definitions were developed addressing the articular bone, cartilage, joint capsule, epiphyseal ossification center, and synovial membrane. In total, 224 US images of knees and ankles were acquired, of which 172 were selected for scoring. An agreement of >80% was not met for any of the definitions, but after modifications, 81-97% agreement was reached. This version of the definitions was approved by 15 US experts. In the final validation exercise, all definitions reached an agreement of >80% for the shoulder, elbow, wrist, metacarpophalangeal hip, knee, ankle and metatarsophalangeal joint. Conclusion. US definitions for the normal pediatric joint were successfully developed through a Delphi process and validated in a practical exercise. These results provide the basis to develop definitions for pathology and to support the standardized use of US in pediatric rheumatology.

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“…A number of studies have described improved sensitivity for detection of joint effusion, synovitis, and bone erosions in RA joints with the use of ultrasound (US) as compared with conventional clinical and radiologic methods (1)(2)(3). Because ultrasonography is a relatively easily accessible and lowcost method, the technique can be used not only by radiologists, but also by trained rheumatologists.…”

mentioning

confidence: 99%

Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis

Szkudlarek¹,

Court‐Payen²,

Jacobsen³

et al. 2003

Arthritis & Rheumatism

664

447

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Objective. To evaluate the interobserver agreement of ultrasonographic assessment of finger and toe joints in patients with rheumatoid arthritis (RA) by 2 investigators with different medical backgrounds.Methods. Ultrasonography and clinical examination were performed on 150 small joints of 30 patients with active RA. A General Electric LOGIQ 500 ultrasound unit with a 7-13-MHz linear array transducer was used. In each patient, 5 preselected small joints (second and third metacarpophalangeal, second proximal interphalangeal, first and second metatarsophalangeal) were examined independently on the same day by 2 ultrasound investigators (an experienced musculoskeletal radiologist and a rheumatologist with limited ultrasound training). Joint effusion, synovial thickening, bone erosions, and power Doppler signal were evaluated in accordance with an introduced 4-grade semiquantitative scoring system, on which the investigators had reached consensus prior to the study.Results. Exact agreement between the 2 observers was seen in 91% of the examinations with regard to bone erosions, in 86% with regard to synovitis, in 79% with regard to joint effusions, and in 87% with regard to power Doppler signal assessments. Conclusion. An experienced radiologist and a rheumatologist with limited ultrasound training achieved high interobserver agreement rates for the identification of synovitis and bone erosions, using an introduced semiquantitative scoring system for ultrasonography of finger and toe joints in RA. Signs of inflammation were more frequently detected with ultrasound than with clinical examination. Ultrasonography may improve the assessment of RA patients by radiologists and rheumatologists.

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Arthritis of the finger joints: A comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging

Cited by 610 publications

References 29 publications

New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier

New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier

Definitions for the Sonographic Features of Joints in Healthy Children

Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis

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