Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years

Abstract

Objective. To determine whether magnetic resonance imaging (MRI) evidence of tendinopathy in early rheumatoid arthritis (RA) could be used to predict the course of tendon involvement in later disease and specifically the risk of tendon rupture.Methods. The occurrence, pattern, and progression of tendinopathy were studied prospectively over 6 years in a cohort of patients who had presented with RA. Of 42 patients enrolled, full MRI and clinical data were available for 31 at 6 years. MRI scans of the dominant wrist were scored for tendinopathy by 2 radiologists using a validated system. These data were compared with MRI synovitis, erosion scores, and disease activity measures. Prognostic factors for tendon inflammation and rupture were sought.Results. Thirty-four patients (81%) had MRI evidence of tendinopathy at baseline, falling to 59% at 1 year and 68% at 6 years. The most commonly affected site was the extensor carpi ulnaris. MRI tendinopathy and synovitis scores were correlated at baseline (r ‫؍‬ 0.37, P ‫؍‬ 0.01) and 1 year (r ‫؍‬ 0.45, P ‫؍‬ 0.003) but not at 6 years (r ‫؍‬ 0.11, P ‫؍‬ 0.5). The strongest predictor of the 6-year tendinopathy score was the 1-year tendinopathy score ( Conclusion. MRI can be used to quantify tendinopathy at the wrist in RA patients. High scores in early disease were predictive of tendon rupture in a small group of patients, but further studies are required to determine whether this has clinical relevance.Tendinopathy involving the extensor tendons of the wrist is observed in 50-64% of patients with rheumatoid arthritis (RA) (1). An important complication is tendon rupture, which has been related both to invasion of the tendon by tenosynovial pannus and fraying of the tendon against eroded bone margins (2,3). Studies of invasive tenosynovium have revealed high levels of matrix metalloproteinases, proinflammatory cytokines, and angiogenic factors, indicating a propensity for damage to neighboring tissues (4). The importance of ongoing tenosynovial inflammation in promoting tendon rupture has been confirmed by observations that prophylactic dorsal tenosynovectomy can prevent this complication in many patients (5). However, the decision to perform surgery is usually made in established cases of RA once

Concepts in diagnosing, scoring, and monitoring tenosynovitis and other tendon abnormalities in patients with rheumatoid arthritis- the role of musculoskeletal ultrasound.

“…Mc Queen et al report tenosynovitis in the dominant wrist, especially in the first year of disease, to be a frequent finding found at MRI examinations [37]. Indeed, another MRI based longitudinal study conducted by Lindegaard et al concluded that tenosynovitis in the dominant wrist and at MCF level was present in about 60 % of the ERA patients at baseline with reduction to 28% after 6 months and a yearfollow-up, showing a good response to therapy superior to the synovitis response [38].…”

“…Moreover, MSUS has been considered by some authors as the "goldstandard" method for the evaluation of superficial tendons [45]. In comparison to MRI it permits not only multi-planar evaluation but also real time dynamic assessment and vasculariza-Overall, MSUS showed a fair to moderate sensitivity but a high specificity [28,29,31,33,37,46,[60][61][62][63][64][65][66][67][68][69][70][71][72].…”

Role of diagnostic ultrasound in the assessment of musculoskeletal diseases

“…Tenosynovitis is common in RA [Hmamouchi et al 2011] but its true prevalence in early disease has not been firmly established. A complication of persistent tenosynovitis is complete rupture of the tendon with loss of function [Mcqueen et al 2005]. Tenosynovitis can be difficult to diagnose clinically in patients with arthritis as pain could easily be attributed to underlying joint involvement.…”

Imaging outcomes and their role in determining outcomes in osteoarthritis and rheumatoid arthritis

“…MRI of a single wrist in patients with early rheumatoid arthritis (evaluated for bone edema and total rheumatoid arthritis abnormalities), however, has been demonstrated to predict the physical function subscale of the Short Form-36 at 6 years of follow-up [49]. In the same cohort, MRI tendinopathy at baseline also predicted tendon rupture at 6 years, although the cohort was small [50].…”