MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years

Abstract

Objectives: To determine whether magnetic resonance (MR) scans of the dominant wrist of patients with early rheumatoid arthritis (RA) can be used to predict functional outcome at 6 years' follow up. Methods: Dominant wrist MR scans were obtained in 42 patients with criteria for RA at first presentation. Patients were followed up prospectively for 6 years, and further scans obtained at 1 year (42 patients) and 6 years (31 patients). Two radiologists scored scans for synovitis, tendonitis, bone oedema, and erosions. The Stanford Health Assessment Questionnaire (HAQ) score, indicating functional outcome, and standard measures of disease activity were assessed at 0, 1, 2, and 6 years. The physical function component of the SF-36 score (PF-SF36) was also used as a functional outcome measure at 6 years. Results: Baseline MR parameters, including bone oedema score and the total baseline MR score, were predictive of the PF-SF36 at 6 years (R 2 = 0.22, p = 0.005 and R 2 = 0.16, p = 0.02, respectively). The PF-SF36 score correlated strongly with the HAQ score at 6 years (r s = 20.725, p,0.0001); none of the baseline MR parameters predicted the 6 year HAQ score. The total MR score obtained at 1 year was predictive of the 6 year HAQ (R 2 = 0.04, p = 0.01). Standard clinical and radiographic measures at baseline were not predictive of the 6 year PF-SF36, but when combined in a model with baseline MR oedema score, prediction increased from 0.09 to 0.23, or 23% of the 6 year variance. Conclusion: MR imaging of the wrist in patients with early RA can help to predict function at 6 years and could be used to plan aggressive management at an earlier stage.

Extremity magnetic resonance imaging in rheumatoid arthritis: Report of the american college of rheumatology extremity magnetic resonance imaging task force

“…Using a sitespecific analysis of MR scans performed in the cohort described above, investigators in McQueen's group showed that baseline MRI-detected bone marrow edema at a specific carpal bone was highly likely to be associated with MRI erosion at that site after 1 year and 6 years (odds ratio 6.5 [95% confidence interval 2.78-18.1]) and the baseline MRI bone marrow edema score was predictive of the 6-year total Sharp score (12,18). A model incorporating baseline MRI scores for erosion, bone marrow edema, synovitis, and tendinitis, plus the C-reactive protein (CRP) level and the erythrocyte sedimentation rate, explained 59% of the variance in the 6-year total Sharp score (R 2 0.59, adjusted R 2 0.44) (12).…”

Ultrasonography and magnetic resonance imaging in early rheumatoid arthritis: Recent advances

“…A relation between baseline MRI findings and longterm functional disability has only been documented in one study [68]. Recently, data from the same cohort revealed that extensive MRI bone edema and erosions at the wrist in early RA predicted tendon dysfunction and impaired hand function [69].…”

Treatment of early rheumatoid arthritis

“…Use of newer techniques, such as magnetic response imaging (MRI), although not yet validated in RA, may well improve the capability of detecting erosive RA early. Magnetic response imaging scans have been reported to detect erosions as early as 4 months after the onset of disease [27][28][29][30] and seem to provide a more precise picture of what is happening in joints, given the fact that bone marrow edema, synovitis, tendonitis, and erosions can be seen in far greater detail. Although MRI may well have many advantages for early diagnosis, the disadvantages include high cost, extended procedure times, the availability of a skilled radiologist trained in reading joint MRIs, and the lack of validation of this procedure as yet.…”