Abstract
Objective
The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA).
Materials and methods
We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session.
Results
The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The “rheumatoid” type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%.
Conclusion
Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with PsA of the hands and wrists. Disease was more extensive in the wrists than in the hands.
Similar content being viewed by others
References
McGonagle D, Conaghan PG, Emery P. Psoriatic arthritis—a unified concept 20 years on. Arthritis Rheum 1999; 42: 1080–1086.
Ory PA, Gladman DD, Mease PJ. Psoriatic arthritis and imaging. Ann Rheum Dis 2005; 64: ii55–ii57.
McQueen FM, Lassere M, Ostergaard M. Magnetic resonance imaging in psoriatic arthritis: a review of the literature. Arthritis Res Ther 2006; 8: 207.
Olivieri I, Salvarani C, Cantini F et al. Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis. Arthritis Rheum 2002; 46: 2964–2967.
Offidani A, Cellini A, Valeri G, Giovagnoni A. Subclinical joint involvement in psoriasis: magnetic resonance imaging and X-ray findings. Acta Derm Venereol 1998; 78: 463–465.
Cimmino MA, Parodi M, Innocenti S et al. Dynamic magnetic resonance of the wrist in psoriatic arthritis reveals imaging patterns similar to those of rheumatoid arthritis. Arthritis Res Ther 2005; 7: R725–R731.
Cantini F, Salvarani C, Olivieri I et al. Distal extremity swelling with pitting edema in psoriatic arthritis: a case-control study. Clin Exp Rheumatol 2001; 19: 291–296.
Tehranzadeh J, Ashikyan O, Anavim A, Tramma S. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis. Skeletal Radiol 2006; 35: 814–822.
Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 1995; 24: 351–355.
Giovagnoni A, Grassi W, Terilli F et al. MRI of the hand in psoriatic and rheumatical arthritis. Eur Radiol 1995; 5: 590–595.
Konig H, Sieper J, Wolf KJ. Rheumatoid arthritis: evaluation of hypervascular and fibrous pannus with dynamic MR imaging enhanced with Gd-DTPA. Radiology 1990; 176: 473–477.
Scarpa R, Mathieu A. Psoriatic arthritis: evolving concepts. Curr Opin Rheumatol 2000; 12: 274–280.
Pierre-Jerome C, Bekkelund SI, Mellgren SI, Torbergsen T, Husby G, Nordstrøm R. The rheumatoid wrist: bilateral MR analysis of the distribution of rheumatoid lesions in axial plan in a female population. Clin Rheumatol 1997; 16: 80–86.
Solomon DH, Katz JN, Bohn R, Mogun H, Avorn J. Nonoccupational risk factors for carpal tunnel syndrome. J Gen Intern Med 1999; 14: 310–314.
Mesgarzadeh M, Schneck CD, Bonakdarpour A, Mitra A, Conaway D. Carpal tunnel: MR imaging. II. Carpal tunnel syndrome. Radiology 1989; 171: 749–754.
Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O. Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheumatol 1999; 26: 1746–1751.
McGonagle D. Imaging the joint and enthesis: insights into pathogenesis of psoriatic arthritis. Ann Rheum Dis 2005; 64: ii58–ii60.
Martel W, Stuck KJ, Dworin AM, Hylland RG. Erosive osteoarthritis and psoriatic arthritis: a radiologic comparison in the hand, wrist, and foot. AJR Am J Roentgenol 1980; 134: 125–135.
McQueen FM, Stewart N, Crabbe J et al. Magnetic resonance imaging in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 1999; 58: 156–163.
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 six years later in patients with rheumatoid arthritis. Arthritis Rheum 2003; 48: 1814–1827.
Ghanem N, Uhl M, Pache G, Bley T, Walker UA, Langer M. MRI in psoriatic arthritis with hand and foot involvement. Rheumatol Int 2007; 27: 387–393.
Milosavljevic J, Lindqvist U, Elvin A. Ultrasound and power Doppler evaluation of the hand and wrist in patients with psoriatic arthritis. Acta Radiol 2005; 46: 374–385.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tehranzadeh, J., Ashikyan, O., Anavim, A. et al. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis. Skeletal Radiol 37, 433–442 (2008). https://doi.org/10.1007/s00256-008-0451-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-008-0451-6