Reliability of Magnetic Resonance Imaging (MRI) Scoring of the Metatarsophalangeal Joints of the Foot according to the Rheumatoid Arthritis MRI Score

Dakkak, Yousra J; Matthijssen, Xanthe M E; Heijde, Desirée van der; Reijnierse, M.; Mil, Annette H M van der Helm-van

doi:10.3899/jrheum.190258

Cited by 15 publications

(11 citation statements)

References 32 publications

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“…Each MRI was scored by two independent readers, blinded to clinical data. Interreader and intrareader intraclass correlation coefficients (ICCs) were generally ≥ 0.90 and were published previously [25]. MRI-detected inflammation was positive per joint if synovitis, tenosynovitis, and/or osteitis were scored as ≥ 1 by both readers independently.…”

Section: Mri Scanning and Scoringsupporting

confidence: 55%

The relation between physical joint examination and MRI-depicted inflammation of metatarsophalangeal joints in early arthritis

et al. 2020

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Background: The relationship between physical joint examination (PE) and MRI-detected inflammation in early inflammatory arthritis has mostly been studied in the hands. Physical examination of MTP joints is considered difficult, and for these joints, this relationship is unknown. Therefore, we studied the concordance of PE with MRI inflammation in MTP joints. Metacarpophalangeal (MCP) joints were included for comparison. Methods: One thousand seven hundred fifty-nine MTP(2-5) and 1750 MCP(2-5) joints of 441 consecutive patients with early arthritis underwent PE (for joint swelling) and MRI, all evaluated by two assessors. MRI was scored for synovitis, tenosynovitis, and osteitis (summed MRI inflammation). Synovial intermetatarsal bursae may enlarge upon inflammation and become palpable and were therefore also assessed. Analyses (frequencies, GEE) were performed on joint level. Results: PE and MRI were concordant in 79% of MTP joints. Of 1606 non-swollen MTP joints, 83% showed no MRI inflammation and 17% showed subclinical MRI inflammation. Of 153 swollen MTP joints, 48% had MRI inflammation and 52% (79 MTP joints) did not. Of these 79 swollen MTP joints without MRI inflammation, 31 showed intermetatarsal bursitis and 48 joints had none of these MRI abnormalities (this concerned 31% of swollen MTP joints). MTP swelling was statistically independently associated with tenosynovitis (OR 2.21, 95% CI 1.1-4.3) and intermetatarsal bursitis (OR 2.91, 95% CI 1.8-4.8). MTP joints showed subclinical inflammation less often than MCP joints (17% vs. 34%, P < 0.001). Swollen MTP joints showed MRI inflammation less often than swollen MCP joints (48% vs. 88%, P < 0.001). Conclusions: The absence of swelling of MTP joints in early arthritis is mostly accompanied by the absence of MRIdetected inflammation. Swollen MTP joints are, in addition to synovitis, also explained by tenosynovitis and intermetatarsal bursitis and partly unexplained by MRI. Their clinical relevance must be determined in longitudinal studies.

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Section: Mri Scanning and Scoringsupporting

confidence: 55%

The relation between physical joint examination and MRI-depicted inflammation of metatarsophalangeal joints in early arthritis

et al. 2020

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“…Interreader and intrareader intraclass correlation coefficients (ICCs) for IMB were 0.90 and 0.85, respectively (see Supplementary Table 1, available on the Arthritis Care & Research website at http://onlinelibrary.wiley.com/doi/10.1002/acr.24640). For the RAMRIS system, interreader and intrareader ICCs were ≥0.90, as published previously (2).…”

Section: Significance and Innovationsmentioning

confidence: 56%

“…Rheumatoid arthritis (RA)–related local inflammation in the hands and forefeet can be reliably and sensitively assessed using magnetic resonance imaging (MRI) ( 1 , 2 ), which is recommended by the European Alliance of Associations for Rheumatology for early detection of RA ( 3 ). Three features of local inflammation are assessed according to the conventionally used RA MRI Scoring (RAMRIS) system: synovitis, tenosynovitis, and osteitis ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Intermetatarsal Bursitis, a Novel Feature of Juxtaarticular Inflammation in Early Rheumatoid Arthritis Related to Clinical Signs: Results of a Longitudinal Magnetic Resonance Imaging Study

Dijk

Dakkak

Matthijssen

et al. 2022

Arthritis Care & Research

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Objective Intermetatarsal bursae in the forefeet possess a synovial lining similar to joints and tendon sheaths. Inflammation of these bursae (intermetatarsal bursitis [IMB]) was recently identified as specific for early rheumatoid arthritis (RA). The present study was undertaken to determine if IMB is indeed an RA feature by assessing the following: 1) the association with other local inflammatory measures (synovitis, tenosynovitis, and osteitis), 2) the association with clinical signs, and 3) whether it responds to disease‐modifying antirheumatic drug (DMARD) therapy similarly to other local inflammatory measures. Methods One hundred fifty‐seven consecutive early RA patients underwent unilateral contrast‐enhanced 1.5T forefoot magnetic resonance imaging (MRI) at diagnosis. MRIs were evaluated for IMB presence and for synovitis, tenosynovitis, and osteitis in line with the RA MRI Scoring (RAMRIS) system (summed as RAMRIS inflammation). MRIs at 4, 12, and 24 months were evaluated for IMB presence and size in patients who had IMB at baseline and received early DMARD therapy. Logistic regression and generalized estimating equations were used. Anti–citrullinated protein antibody (ACPA) stratification was performed. Results Sixty‐nine percent of RA patients had ≥1 IMB. In multivariable analysis on bursa level, presence of IMB was independently associated with local presence of synovitis and tenosynovitis, with odds ratios (OR) of 1.69 (95% confidence interval [95% CI] 1.12, 2.57) and 2.83 (95% CI 1.80, 4.44), respectively, but not osteitis. On the patient level, IMB presence was most strongly associated with tenosynovitis (OR 2.92 [95% CI 1.62, 5.24]). IMB presence was associated with local joint swelling (OR 2.7 [95% CI 1.3, 5.3]) and tenderness (OR 1.7 [95% CI 1.04, 2.9]) independent of RAMRIS inflammation. During treatment, IMB size decreased between 0 and 12 months. This decrease associated with decrease in RAMRIS inflammation, which was driven by synovitis decrease. Within ACPA‐positive and ACPA‐negative RA, similar results were obtained. Conclusion IMB particularly accompanies inflammation of the synovial lining of joints and tendon sheaths, showed a similar treatment response after DMARD initiation, and associates with typical clinical signs. These findings suggest that IMB represents a frequently present novel RA feature of juxtaarticular synovial inflammation.

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“…n Tendons crossing metatarsophalangeal (MTP) joints had a synovial sheath (microscopically and macroscopically) at the flexor and extensor sides. OMERACT RAMRIS were designed for scoring inflammation in the hands and were found reliable when applied to the MTP joints (27,28). All tendons, joints, and bones were scored on a scale of 0-3.…”

Section: Key Resultsmentioning

confidence: 99%

Rheumatoid Arthritis and Tenosynovitis at the Metatarsophalangeal Joints: An Anatomic and MRI Study of the Forefoot Tendon Sheaths

et al. 2020

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R heumatoid arthritis (RA) is a chronic autoimmune disease that is characterized by inflammation of the synovial joints (1). MRI is recommended for the early detection of inflammation in RA because it is sensitive in measuring synovitis, bone marrow edema (BME), and tenosynovitis (2). Tenosynovitis is defined as inflammation of the synovial lining of the tendon sheaths. MRI studies have shown that tenosynovitis at the level of the metacarpophalangeal and wrist joints is an early phenomenon in patients at risk for RA that is predictive of development of RA (3-5) and, compared with patients with arthritis from other causes, is highly specific for RA (6). In addition, tenosynovitis is associated with functional impairment in daily life (7,8).Tendon sheaths help prevent tendon injury and help with load bearing (9). Not all tendons possess a sheath; for example, at the metacarpophalangeal joints a sheath is present around the flexor tendons but is believed to be absent around the extensor tendons (6). Regarding the metatarsophalangeal (MTP) joints, there is no consensus in the anatomic literature regarding the presence or absence of a tendon sheath. On the extensor side of the MTP joints, some sources portray extensor tendons without sheaths (10-12) and other sources do not provide information about this region (13). Regarding the flexor side of the MTP joints, there is controversy between sources. In one example a fibrous and synovial sheath is portrayed around the distal flexor tendons (10), in another case it is described

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Reliability of Magnetic Resonance Imaging (MRI) Scoring of the Metatarsophalangeal Joints of the Foot according to the Rheumatoid Arthritis MRI Score

Cited by 15 publications

References 32 publications

The relation between physical joint examination and MRI-depicted inflammation of metatarsophalangeal joints in early arthritis

The relation between physical joint examination and MRI-depicted inflammation of metatarsophalangeal joints in early arthritis

Intermetatarsal Bursitis, a Novel Feature of Juxtaarticular Inflammation in Early Rheumatoid Arthritis Related to Clinical Signs: Results of a Longitudinal Magnetic Resonance Imaging Study

Rheumatoid Arthritis and Tenosynovitis at the Metatarsophalangeal Joints: An Anatomic and MRI Study of the Forefoot Tendon Sheaths

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