MRI identifies plantar plate pathology in the forefoot of patients with rheumatoid arthritis

Abstract

Previous cadaveric studies have suggested that forefoot deformities at the metatarsophalangeal (MTP) joints in patients with rheumatoid arthritis (RA) might result from the failure of the ligamentous system and displacement of the plantar plates. This study aimed to examine the relationship between plantar plate pathology and the rheumatoid arthritis magnetic resonance imaging score (RAMRIS) of the lesser (second to fifth) MTP joints in patients with RA using high-resolution 3 T magnetic resonance imaging (MRI). In 24 patients with RA, the forefoot was imaged using 3 T MRI. Proton density fat-suppressed, T2-weighted fat-suppressed and T1-weighted post gadolinium sequences were acquired through 96 lesser MTP joints. Images were scored for synovitis, bone marrow oedema and bone erosion using the RAMRIS system and the plantar plates were assessed for pathology. Seventeen females and 7 males with a mean age of 55.5 years (range 37–71) and disease duration of 10.6 years (range 0.6–36) took part in the study. Plantar plate pathology was most frequently demonstrated on MRI at the fifth MTP joint. An association was demonstrated between plantar plate pathology and RAMRIS-reported synovitis, bone marrow oedema and bone erosion at the fourth and fifth MTP joints. In patients with RA, 3 T MRI demonstrates that plantar plate pathology at the lesser MTP joints is associated with features of disease severity. Plantar plate pathology is more common at the fourth and fifth MTP joints in subjects with RA in contrast to the predilection for the second MTP reported previously in subjects without RA.

Magnetic Resonance Arthrography of Lesser Metatarsophalangeal Joints in Patients with Rheumatoid Arthritis: Relationship to Clinical, Biomechanical, and Radiographic Variables

“…A recent MRI study has demonstrated that focal deficiencies attributed to plantar plate pathology of the lesser (second to fifth) MTP joints are common in the forefoot of patients with RA and associated with synovitis, bone edema, and bone erosion 13 .…”

Validity of the rheumatoid arthritis MRI score applied to the forefeet using the OMERACT filter: a systematic literature review

“…Regarding construct validity, three studies were deemed to have MRI-data of high quality 16 20 22. Synovitis was associated with plantar plate pathology, which represents a failure of the ligamentous system and displacement of the plantar plates of the forefoot leading to malformation 22. When patients were followed for up to 24 months, MRI-detected synovitis was not associated with radiographic damage 20.…”

Rheumatic Diseases

“…The advantage of MRI over radiography, apart from the absence of ionizing radiation, is the superior imaging of the structures in RA, such as synovial tissue, tendons, sheaths, ligaments, bone, and cartilage (Baan et al 2011). A recent MRI study has demonstrated that focal deficiencies attributed to plantar plate pathology of the lesser (second to fifth) MTP joints are common in the forefoot of patients with RA and associated with synovitis, bone oedema, and bone erosion (Siddle et al 2012a). In a more recent study, MRI arthrography demonstrated pathology at 18 of 28 lesser MTP joints (64%) examined in 15 patients with RA (Siddle et al 2012b).…”