Table 2.

The OMERACT MRI in Arthritis Working Group’s updated 2016 recommendations of the OMERACT RA MRI scoring system (OMERACT 2016 RAMRIS).

Bone erosion
  • Each bone (wrists: distal radius, distal ulna, carpal bones, metacarpal bases; MCP joints: metacarpal heads, phalangeal bases) is scored separately

  • The scale is 0–10, based on the proportion of eroded bone compared to the “assessed bone volume,” judged on all available images: 0 = no erosion; 1 = 1–10% of bone eroded; 2 = 11–20%, etc. For long bones, the “assessed bone volume” is from the articular surface (or its best estimated position if absent) to a depth of 1 cm, while in carpal bones it is the whole bone

  • In case a bone is fused with another bone, bone erosion is scored as 10 in the bone

Osteitis/bone marrow edema
  • Each bone is scored separately (as for erosions)

  • The scale is 0–3 based on the proportion of bone with osteitis, as follows: 0 = no osteitis; 1 = 1–33% of bone with osteitis; 2 = 34–66%; 3 = 67–100%

  • Synovitis is assessed in 3 wrist regions (1. the distal radioulnar joint; 2. the radiocarpal joint; 3. the intercarpal and carpometacarpal joints) and in each MCP joint. The first carpometacarpal joint is not scored

  • The scale is 0–3. Score 0 is normal, while 1–3 (mild, moderate, severe) are by thirds of the presumed maximum volume of enhancing tissue in the synovial compartment

Joint space narrowing
  • Joint space narrowing is assessed at 17 locations in the wrist, between distal radius and carpal bones (2 sites), between the carpal bones (except the pisiform; 10 sites), and between carpal bones and each metacarpal bone (5 sites), and in each MCP joint

  • The scale is 0–4, as follows: 0 = no narrowing; 1 = focal or mild (< 33%) narrowing; 2 = moderate (34–66%) narrowing; 3 = moderate to severe (67–99%) narrowing; 4 = ankylosis

  • In the wrist, tenosynovitis is assessed at 6 extensor tendon compartments and 3 flexor tendon compartments, between the radioulnar joint and the hook of hamate. At the level of the MCP joints, flexor tendons are assessed in an area from 1 cm proximal to 1 cm distal to each joint

  • Tenosynovitis is scored based on the maximum width of the effusion and/or tenosynovial enhancement measured perpendicularly to the tendon

  • The scale is 0–3, as follows: 0 = no; 1 = < 1.5 mm; 2 = ≥ 1.5 mm but < 3 mm; 3 = ≥ 3 mm peritendinous effusion and/or postcontrast tenosynovial enhancement

  • OMERACT: Outcome Measures in Rheumatology; MRI: magnetic resonance imaging; RA: rheumatoid arthritis; RAMRIS: Rheumatoid Arthritis Magnetic Resonance Imaging Scoring system; MCP: metacarpophalangeal.