The value of conventional views and radiographic magnification in evaluating early rheumatoid arthritis

Hartley, Robert M.; Liang, Matthew H.; Weissman, Barbara N.; Sosman, J. Leland; Katz, Robert I.; Charlton, John

doi:10.1002/art.1780270704

Cited by 21 publications

(6 citation statements)

References 14 publications

(10 reference statements)

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“…Almost all patients had abnormal findings on radiographic and physical examinations. Our findings confirm that articular damage is greater in the dominant hand (27), although we did not find statistically significant differences, and that extensive radiographic changes are detectable using only a single PA radiograph of both hands and wrists (28,29).…”

Section: Acknowledgmentssupporting

confidence: 71%

Radiographic and joint count findings of the hand in rheumatoid arthritis. related and unrelated findings

Fuchs

Callahan

Kaye

et al. 1988

Arthritis & Rheumatism

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Radiographic and physical joint count findings of the hands and wrists of 148 patients with rheumatoid arthritis (RA) were analyzed in a cross‐sectional study. Quantitative radiographic scores for joint space narrowing, erosion, and malalignment were correlated highly with joint count scores for limitation of motion and deformity, and were correlated at considerably lower levels with joint swelling scores. Radiographic scores, however, were not correlated at all with joint count tenderness scores. That 2 of the most widely used indices of RA disease activity, radiographic erosion scores and joint count scores for tenderness, were independent of one another at a selected timepoint, should be considered in the design of clinical trials and long‐term observation of patients with RA.

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Section: Acknowledgmentssupporting

confidence: 71%

Radiographic and joint count findings of the hand in rheumatoid arthritis. related and unrelated findings

Fuchs

Callahan

Kaye

et al. 1988

Arthritis & Rheumatism

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“…The early and accurate diagnosis of RA has become more relevant with the availability of expensive but effective therapies (6,7). Several studies have previously demonstrated the relative lack of sensitivity of conventional posteroanterior (PA) radiography compared with other radiographic techniques (8)(9)(10)(11)(12)(13). Improvement in the ability to detect erosions, especially in early disease, would therefore be a significant clinical advance.…”

mentioning

confidence: 99%

The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: A comparison with conventional radiography

Wakefield

Gibbon

Conaghan

et al. 2000

Arthritis & Rheumatism

659

289

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Objective The ability to make an early, accurate diagnosis of rheumatoid arthritis (RA) has become increasingly important with the availability of new, expensive, and targeted therapies. However, plain radiography, the traditional method of detecting the characteristic bone erosions and an important adjunct in establishing a diagnosis of RA, is known to be insensitive. This study compared sonography, a modern imaging technique, with conventional radiography for the detection of erosions in the metacarpophalangeal (MCP) joints of patients with RA. Methods One hundred RA patients (including 40 with early disease) underwent posteroanterior radiography and sonography of the MCP joints of the dominant hand. Twenty asymptomatic control subjects also underwent sonography. Erosion sites were recorded and subsequently compared using each modality. Magnetic resonance imaging (MRI) was performed on the second MCP joint in 25 patients with early RA to confirm the pathologic specificity of sonographic erosions. Intraobserver reliability of sonography readings was assessed using video recordings of 55 MCP joint scans of RA patients, and interobserver reliability was assessed by comparing 160 MCP joint scans performed sequentially by 2 independent observers. Results Sonography detected 127 definite erosions in 56 of 100 RA patients, compared with radiographic detection of 32 erosions (26 [81%] of which coincided with sonographic erosions) in 17 of 100 patients (P < 0.0001). In early disease, sonography detected 6.5‐fold more erosions than did radiography, in 7.5‐fold the number of patients. In late disease, these differences were 3.4‐fold and 2.7‐fold, respectively. On MRI, all sonographic erosions not visible on radiography (n = 12) corresponded by site to MRI abnormalities. The Cohen‐kappa values for intra‐ and interobserver reliability of sonography were 0.75 and 0.76, respectively. Conclusion Sonography is a reliable technique that detects more erosions than radiography, especially in early RA. Sonographic erosions not seen on radiography corresponded to MRI bone abnormalities. This technology has potential in the management of patients with early RA/inflammatory arthritis and is likely to have major implications for the future practice of rheumatology.

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“…Conventional radiography is currently regarded as the standard of reference for detecting and quantifying destructive joint processes in arthritis, although its sensitivity limits its usefulness in depicting early arthritic joint lesions. [7][8][9][10][11][12] Ultrasonography (US) and magnetic resonance imaging (MRI) are alternative diagnostic modalities for demonstrating early arthritis. [12][13][14] This article reports the first prospective long term study comparing different novel and conventional imaging modalities for diagnosing early arthritis of the finger joints.…”

mentioning

confidence: 99%

Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints

Backhaus

Burmester²,

Sandrock³

et al. 2002

Annals of the Rheumatic Diseases

250

130

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Objective: To carry out a prospective two year follow up study comparing conventional radiography, three-phase bone scintigraphy, ultrasonography (US), and three dimensional (3D) magnetic resonance imaging (MRI) with precontrast and dynamic postcontrast examination in detecting early arthritis. The aim of the follow up study was to monitor the course of erosions during treatment with disease modifying antirheumatic drugs by different modalities and to determine whether the radiographically occult changes like erosive bone lesions of the finger joints detected by MRI and US in the initial study would show up on conventional radiographs two years later. Additionally, to study the course of soft tissue lesions depicted in the initial study in comparison with the clinical findings. Methods: The metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints (14 joints) of the clinically more severely affected hand (soft tissue swelling and joint tenderness) as determined in the initial study of 49 patients with various forms of arthritis were examined twice. The patients had initially been divided into two groups. The follow up group I included 28 subjects (392 joints) without radiographic signs of destructive arthritis (Larsen grades 0-1) of the investigated hand and wrist, and group II (control group) included 21 patients (294 joints) with radiographs showing erosions (Larsen grade 2) of the investigated hand or wrist, or both, at the initial examination. Results: (1) Radiography at the two year follow up detected only two erosions (two patients) in group I and 10 (nine patients) additional erosions in group II. Initial MRI had already detected both erosions in group I and seven (seven patients) of the 10 erosions in group II. Initial US had depicted one erosion in group I and four of the 10 erosions in group II. (2) In contrast with conventional radiography, 3D MRI and US demonstrated an increase in erosions in comparison with the initial investigation. (3) The abnormal findings detected by scintigraphy were decreased at the two year follow up. (4) Both groups showed a marked clinical improvement of synovitis and tenosynovitis, as also shown by MRI and US. (5) There was a striking discrepancy between the decrease in the soft tissue lesions as demonstrated by clinical findings, MRI, and US, and the significant increase in erosive bone lesions, which were primarily evident at MRI and US. Conclusions: Despite clinical improvement and a regression of inflammatory soft tissue lesions, erosive bone lesions were increased at the two year follow up, which were more pronounced with 3D MRI and less pronounced with US. The results of our study suggest that owing to the inadequate depiction of erosions and soft tissue lesions, conventional radiography alone has limitations in the intermediate term follow up of treatment. US has a high sensitivity for depicting inflammatory soft tissue lesions, but dynamic 3D MRI is more sensitive in differentiating minute erosions.

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The value of conventional views and radiographic magnification in evaluating early rheumatoid arthritis

Cited by 21 publications

References 14 publications

Radiographic and joint count findings of the hand in rheumatoid arthritis. related and unrelated findings

Radiographic and joint count findings of the hand in rheumatoid arthritis. related and unrelated findings

The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: A comparison with conventional radiography

Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints

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