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Advanced imaging in rheumatoid arthritis

Part 2: Erosions

  • Review Article
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Abstract

Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disorder primarily affecting the synovium. We now recognise that conventional radiographic images show changes of rhuematoid arthritis late after irreversible joint damage has occured. With the advent of powerful disease-modifying drugs there is a need for early demonstration of rheumatoid arthritis and to monitor progress of the disease and response to therapy. Advanced imaging techniques such as ultrasound and MRI have focussed on the demonstration and quanitification of synovitis and erosions and allow early diagnosis of RA. The technology to quantify synovitis and erosions is developing rapidly and now allows change in disease activity to be assessed. However, problems undoubtedly exist in quantification techniques and this review serves to highlight them. Much of the literature on advanced imaging in RA appears in rheumatological journals and may not be familiar to radiologists. This review article aims to increase the awareness of radiologists to this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. This first part addresses synovitis imaging. The second part will look at advanced imaging of erosions in RA.

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References

  1. Brower AC. Use of the radiograph to measure the course of rheumatoid arthritis. The gold standard versus fool’s gold. Arthritis Rheum 1990;33:316–24.

    Article  CAS  Google Scholar 

  2. Pierre-Jerome C, Bekkelund SI, Mellgren SI, et al. The rheumatoid wrist: bilateral MR analysis of the distribution of rheumatoid lesions in axial plan in a female population. Clin Rheumatol 1997;16:80–6.

    Article  CAS  Google Scholar 

  3. van der Heijde DM. Joint erosions and patients with early rheumatoid arthritis. Br J Rheumatol 1995;34(Suppl 2):74–8.

    Article  Google Scholar 

  4. van der Heijde DM, van Riel PL, van Leeuwen MA, et al. Prognostic factors for radiographic damage and physical disability in early rheumatoid arthritis. A prospective follow-up study of 147 patients. Br J Rheumatol 1992;31:519–25.

    Article  Google Scholar 

  5. Korpela M, Laasonen L, Hannonen P, et al. Retardation of joint damage in patients with early rheumatoid arthritis by initial aggressive treatment with disease-modifying antirheumatic drugs: 5-year experience from the FIN-RACo study. Arthritis Rheum 2004;50:2072–81.

    Article  CAS  Google Scholar 

  6. Tehranzadeh J, Ashikyan O, Dascalos J. Magnetic resonance imaging in early detection of rheumatoid arthritis. Semin Musculoskelet Radiol 2003;7:79–94.

    Article  Google Scholar 

  7. Di Franco M, Spadaro A, Mauceri MT, et al. Relationship of rheumatoid factor isotype levels with joint lesions detected by magnetic resonance imaging in early rheumatoid arthritis. Rev Rhum Engl Ed 1999;66:251–5.

    PubMed  Google Scholar 

  8. McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at 4 months after symptom onset. Ann Rheum Dis 1998;57:350–6.

    Article  CAS  Google Scholar 

  9. Taylor PC. VEGF and imaging of vessels in rheumatoid arthritis. Arthritis Res 2002;4(Suppl 3):S99–107.

    Article  Google Scholar 

  10. Kirwan JR. The relationship between synovitis and erosions in rheumatoid arthritis. Br J Rheumatol 1997;36:225–8.

    Article  CAS  Google Scholar 

  11. McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 1999;58:156–63.

    Article  CAS  Google Scholar 

  12. McQueen FM, Benton N, Perry D, et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet 6 years later in patients with rheumatoid arthritis. Arthritis Rheum 2003;48:1814–27.

    Article  Google Scholar 

  13. Lipsky PE, van der Heijde DM, St Clair EW, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N Engl J Med 2000;343:1594–602.

    Article  CAS  Google Scholar 

  14. Boers M, Kostense PJ, Verhoeven AC, et al. Inflammation and damage in an individual joint predict further damage in that joint in patients with early rheumatoid arthritis. Arthritis Rheum 2001;44:2242–6.

    Article  CAS  Google Scholar 

  15. McGonagle D, Conaghan PG, O’Connor P, et al. The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study. Arthritis Rheum 1999;42:1706–11.

    Article  CAS  Google Scholar 

  16. Savnik A, Malmskov H, Thomsen HS, et al. Magnetic resonance imaging of the wrist and finger joints in patients with inflammatory joint diseases. J Rheumatol 2001;28:2193–200.

    CAS  PubMed  Google Scholar 

  17. Savnik A, Malmskov H, Thomsen HS, et al. MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions. Eur Radiol 2002;12:1203–10.

    Article  Google Scholar 

  18. Conaghan PG, O’Connor P, McGonagle D, et al. Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum 2003;48:64–71.

    Article  Google Scholar 

  19. Ostergaard M, Hansen M, Stoltenberg M, et al. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 1999;42:918–29.

    Article  CAS  Google Scholar 

  20. McQueen FM. Magnetic resonance imaging in early inflammatory arthritis: what is its role? Rheumatology (Oxford) 2000;39:700–6.

    Article  CAS  Google Scholar 

  21. Lindegaard H, Vallo J, Horslev-Petersen K, et al. Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset. Ann Rheum Dis 2001;60:770–6.

    Article  CAS  Google Scholar 

  22. Sugimoto H, Takeda A, Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology 2000;216:569–75.

    Article  CAS  Google Scholar 

  23. Wakefield RJ, Gibbon WW, Conaghan PG, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000;43:2762–70.

    Article  CAS  Google Scholar 

  24. Alasaarela E, Suramo I, Tervonen O, et al. Evaluation of humeral head erosions in rheumatoid arthritis: a comparison of ultrasonography, magnetic resonance imaging, computed tomography and plain radiography. Br J Rheumatol 1998;37:1152–6.

    Article  CAS  Google Scholar 

  25. Cimmino MA, Bountis C, Silvestri E, et al. An appraisal of magnetic resonance imaging of the wrist in rheumatoid arthritis. Semin Arthritis Rheum 2000;30:180–95.

    Article  CAS  Google Scholar 

  26. Ostergaard M, Peterfy C, Conaghan P, et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 2003;30:1385–6.

    PubMed  Google Scholar 

  27. Ostendorf B, Peters R, Dann P, et al. Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis. Arthritis Rheum 2001;44:2492–502.

    Article  CAS  Google Scholar 

  28. Perry D, Stewart N, Benton N, et al. Detection of erosions in the rheumatoid hand; a comparative study of multidetector computerized tomography versus magnetic resonance scanning. J Rheumatol 2005;32:256–67.

    PubMed  Google Scholar 

  29. McQueen F, Lassere M, Edmonds J, et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies. Summary of OMERACT 6 MR Imaging Module. J Rheumatol 2003;30:1387–92.

    PubMed  Google Scholar 

  30. Foley-Nolan D, Stack JP, Ryan M, et al. Magnetic resonance imaging in the assessment of rheumatoid arthritis–a comparison with plain film radiographs. Br J Rheumatol 1991;30:101–6.

    Article  CAS  Google Scholar 

  31. Jorgensen C, Cyteval C, Anaya JM, et al. Sensitivity of magnetic resonance imaging of the wrist in very early rheumatoid arthritis. Clin Exp Rheumatol 1993;11:163–8.

    CAS  PubMed  Google Scholar 

  32. Ostergaard M, Gideon P, Sorensen K, et al. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist. Scand J Rheumatol 1995;24:212–8.

    Article  CAS  Google Scholar 

  33. Klarlund M, Ostergaard M, Gideon P, et al. Wrist and finger joint MR imaging in rheumatoid arthritis. Acta Radiol 1999;40:400–9.

    Article  CAS  Google Scholar 

  34. Klarlund M, Ostergaard M, Jensen KE, et al. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: 1 year follow-up of patients with early arthritis. The TIRA Group. Ann Rheum Dis 2000;59:521–8.

    Article  CAS  Google Scholar 

  35. McQueen FM, Benton N, Crabbe J, et al. What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using x rays and magnetic resonance imaging over the first 2 years of disease. Ann Rheum Dis 2001;60:859–68.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. McGonagle D, Gibbon W, O’Connor P, et al. Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 1998;41:694–700.

    Article  CAS  Google Scholar 

  37. Ostergaard M, Hansen M, Stoltenberg M, et al. New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of 2 years earlier. Arthritis Rheum 2003;48:2128–31.

    Article  Google Scholar 

  38. Conaghan P, Lassere M, Ostergaard M, et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 4: an international multicenter longitudinal study using the RA-MRI Score. J Rheumatol 2003;30:1376–9.

    PubMed  Google Scholar 

  39. Lassere M, McQueen F, Ostergaard M, et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI score. J Rheumatol 2003;30:1366–75.

    PubMed  Google Scholar 

  40. Bird P, Lassere M, Shnier R, et al. Computerized measurement of magnetic resonance imaging erosion volumes in patients with rheumatoid arthritis: a comparison with existing magnetic resonance imaging scoring systems and standard clinical outcome measures. Arthritis Rheum 2003;48:614–24.

    Article  Google Scholar 

  41. Ostergaard M, Stoltenberg M, Gideon P, et al. Changes in synovial membrane and joint effusion volumes after intraarticular methylprednisolone. Quantitative assessment of inflammatory and destructive changes in arthritis by MRI. J Rheumatol 1996;23:1151–61.

    CAS  PubMed  Google Scholar 

  42. Bird P, Conaghan P, Ejbjerg B, et al. The development of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis 2005;64(Suppl 1):i8–10.

    Article  Google Scholar 

  43. McQueen F, Ostergaard M, Peterfy C, et al. Pitfalls in scoring MR images of rheumatoid arthritis wrist and metacarpophalangeal joints. Ann Rheum Dis 2005;64(Suppl 1):i48–55.

    Article  Google Scholar 

  44. Ejbjerg B, Narvestad E, Rostrup E, et al. Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis. Arthritis Rheum 2004;50:1097–106.

    Article  Google Scholar 

  45. Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005;32:2485–7.

    PubMed  Google Scholar 

  46. Mc Gonagle D, Gibbon W, O’Connor P, et al. A preliminary study of ultrasound aspiration of bone erosion in early rheumatoid arthritis. Rheumatology (Oxford) 1999;38:329–31.

    Article  Google Scholar 

  47. Weidekamm C, Koller M, Weber M, et al. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 2003;48:325–33.

    Article  CAS  Google Scholar 

  48. Szkudlarek M, Court-Payen M, Jacobsen S, et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48:955–62.

    Article  Google Scholar 

  49. Magnani M, Salizzoni E, Mule R, et al. Ultrasonography detection of early bone erosions in the metacarpophalangeal joints of patients with rheumatoid arthritis. Clin Exp Rheumatol 2004;22:743–8.

    CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, Leeds Teaching Hospitals, Leeds, UK

    J. M. Farrant, A. J. Grainger & P. J. O’Connor

  2. Department of Radiology, Chapel Allerton Hospital, Chapel Town Road, Leeds, LS8 4SA, UK

    A. J. Grainger

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  1. J. M. Farrant
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  2. A. J. Grainger
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  3. P. J. O’Connor
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Corresponding author

Correspondence to A. J. Grainger.

Additional information

Part 1 of this article (Synovitis) can be found at: https://doi.org/10.1007/s00256-006-0219-9.

In our previous article we described issues surrounding the advanced imaging of synovitis. This article addresses erosions in a similar manner.

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Farrant, J.M., Grainger, A.J. & O’Connor, P.J. Advanced imaging in rheumatoid arthritis. Skeletal Radiol 36, 381–389 (2007). https://doi.org/10.1007/s00256-006-0220-3

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  • DOI: https://doi.org/10.1007/s00256-006-0220-3

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