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Characterisation of hand small joints arthropathy using high-resolution MRI—Limited discrimination between osteoarthritis and psoriatic arthritis

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To test the hypothesis that microanatomical differences in joint disease localisation could be exploited using high-resolution MRI to better differentiate among rheumatoid arthritis (RA), spondyloarthritis/psoriatic arthritis (SpA/PsA) and osteoarthritis (OA) in clinical practice.

Methods

Sixty-nine patients with suspected inflammatory joint disease of the hand or feet underwent high-resolution MRI using a small loop coil. Images were scored blinded to the clinical status. Various joint changes like periostitis, osteitis, erosions, enthesitis and synovitis were recorded. The image-based diagnosis was compared with the clinical diagnosis.

Results

In 59.4 % of the patients the clinical diagnosis was confirmed on image analysis. This was high for OA (80 %), moderately good for RA (67 %) but only 50 % for SpA/PsA. The major difficulty was to distinguish OA from SpA/PsA where common imaging findings are evident including periostitis (SpA/PsA 45 %, OA 40 % compared with RA 0 %; P = 0.015). Likewise, osteitis was frequently detected in SpA/PsA (79 %) and OA (80 %) and less frequently in RA (42 %) (P = 0.014).

Conclusion

Characterisation of inflammatory disorders of small joints merely using high-resolution MRI remains challenging especially in the differentiation between OA and PsA. These findings are likely explained by common microanatomical similarities in disease expression rather than limitations of imaging techniques.

Key Points

• High-resolution MRI is increasingly used to investigate joint disease.

• Osteitis and periostitis occur in psoriatic and osteoarthritis (but not rheumatoid arthritis).

• In severely affected patients the amount of synovitis and erosions is similar.

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References

  1. Goldbach-Mansky R, Lee J, McCoy A et al (2000) Rheumatoid arthritis associated autoantibodies in patients with synovitis of recent onset. Arthritis Res 2:236–243

    Article  PubMed  CAS  Google Scholar 

  2. Tan AL, Grainger AJ, Tanner SF, Emery P, McGonagle D (2006) A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthritis Rheum 54:1328–1333

    Article  PubMed  Google Scholar 

  3. Backhaus M, Kamradt T, Sandrock D et al (1999) Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 42:1232–1245

    Article  PubMed  CAS  Google Scholar 

  4. Taouli B, Zaim S, Peterfy CG et al (2004) Rheumatoid arthritis of the hand and wrist: comparison of three imaging techniques. AJR Am J Roentgenol 182:937–943

    Article  PubMed  Google Scholar 

  5. Savnik A, Malmskov H, Thomsen HS et al (2002) MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions. Eur Radiol 12:1203–1210

    Article  PubMed  Google Scholar 

  6. Sugimoto H, Takeda A, Hyodoh K (2000) Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology 216:569–575

    PubMed  CAS  Google Scholar 

  7. Dohn UM, Ejbjerg BJ, Court-Payen M et al (2006) Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther 8:R110

    Article  PubMed  Google Scholar 

  8. Scherer A, Wirrwar A, Mattes-Gyorgy K et al (2009) Bony pathologies of the metacarpophalangeal joints in early rheumatoid arthritis: comparison of MRI and high-resolution SPECT. Rofo 181:875–880

    Article  PubMed  CAS  Google Scholar 

  9. McGonagle D, Conaghan PG, O’Connor P et al (1999) The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study. Arthritis Rheum 42:1706–1711

    Article  PubMed  CAS  Google Scholar 

  10. Mease PJ (2011) Psoriatic arthritis: update on pathophysiology, assessment and management. Ann Rheum Dis 70(Suppl 1):i77–84

    Article  PubMed  Google Scholar 

  11. Tan AL, McGonagle D (2010) Psoriatic arthritis: correlation between imaging and pathology. Joint Bone Spine 77:206–211

    Article  PubMed  Google Scholar 

  12. Tan AL, Grainger AJ, Tanner SF et al (2005) High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum 52:2355–2365

    Article  PubMed  Google Scholar 

  13. Ostergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386

    PubMed  Google Scholar 

  14. Østergaard M, Bøyesen P, Eshed I et al (2011) Development and preliminary validation of an MRI joint space narrowing score for use in rheumatoid arthritis: a potential adjunct to the OMERACT RA MRI scoring system. J Rheumatol 38:2045–2050

    Article  PubMed  Google Scholar 

  15. Ostergaard M, McQueen F, Wiell C et al (2009) The OMERACT psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS): definitions of key pathologies, suggested MRI sequences, and preliminary scoring system for PsA hands. J Rheumatol 36:1816–1824

    Article  PubMed  Google Scholar 

  16. Aletaha D, Neogi T, Silman AJ et al (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581

    Article  PubMed  Google Scholar 

  17. Moll JM, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3:55–78

    Article  PubMed  CAS  Google Scholar 

  18. Dougados M, van der Linden S, Juhlin R et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227

    Article  PubMed  CAS  Google Scholar 

  19. Boutry N, Hachulla E, Flipo RM, Cortet B, Cotten A (2005) MR imaging findings in hands in early rheumatoid arthritis: comparison with those in systemic lupus erythematosus and primary Sjogren syndrome. Radiology 236:593–600

    Article  PubMed  Google Scholar 

  20. Marzo-Ortega H, Tanner SF, Rhodes LA et al (2009) Magnetic resonance imaging in the assessment of metacarpophalangeal joint disease in early psoriatic and rheumatoid arthritis. Scand J Rheumatol 38:79–83

    Article  PubMed  CAS  Google Scholar 

  21. Tan AL, Benjamin M, Toumi H et al (2007) The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis—a high-resolution MRI and histological study. Rheumatology (Oxford) 46:253–256

    Article  CAS  Google Scholar 

  22. Jimenez-Boj E, Nobauer-Huhmann I, Hanslik-Schnabel B et al (2007) Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum 56:1118–1124

    Article  PubMed  Google Scholar 

  23. Marzo-Ortega H, O’Connor P, Emery P, McGonagle D (2007) Sacroiliac joint biopsies in early sacroiliitis. Rheumatology (Oxford) 46:1210–1211

    Article  CAS  Google Scholar 

  24. Hodgson R, Grainger A, O’Connor P, Barnes T, Connolly S, Moots R (2008) Dynamic contrast enhanced MRI of bone marrow oedema in rheumatoid arthritis. Ann Rheum Dis 67:270–272

    Article  PubMed  CAS  Google Scholar 

  25. Cimmino MA, Parodi M, Innocenti S et al (2005) Dynamic magnetic resonance of the wrist in psoriatic arthritis reveals imaging patterns similar to those of rheumatoid arthritis. Arthritis Res Ther 7:R725–731

    Article  PubMed  Google Scholar 

  26. Hermann KG (2006) Magnetic resonance imaging of the hand in rheumatoid arthritis. New scientific insights and practical application. Radiologe 46:384–393

    Article  PubMed  Google Scholar 

  27. McGonagle D, Tan AL, Grainger AJ, Benjamin M (2008) Heberden’s nodes and what Heberden could not see: the pivotal role of ligaments in the pathogenesis of early nodal osteoarthritis and beyond. Rheumatology (Oxford) 47:1278–1285

    Article  CAS  Google Scholar 

  28. Schoellnast H, Deutschmann HA, Hermann J et al (2006) Psoriatic arthritis and rheumatoid arthritis: findings in contrast-enhanced MRI. AJR Am J Roentgenol 187:351–357

    Article  PubMed  Google Scholar 

  29. Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O (1995) Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 24:351–355

    Article  PubMed  CAS  Google Scholar 

  30. Eshed I, Feist E, Althoff CE et al (2009) Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis. Rheumatology (Oxford) 48:887–891

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Charité Medical School, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Leonie S. Braum, Torsten Diekhoff, Bernd Hamm & Kay-Geert A. Hermann

  2. Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine and Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK

    Dennis McGonagle & Ai Lyn Tan

  3. Department of Rheumatology and Immunology, Charité Medical School, Berlin, Germany

    Anne Bruns & Karlfried Aupperle

  4. Department of Dermatology, Psoriasis Study Centre, Charité Medical School, Berlin, Germany

    Sandra Philipp

  5. Department of Gastroenterology, Infectiology and Rheumatology, Charité Medical School, Berlin, Germany

    Sandra Hermann

Authors
  1. Leonie S. Braum
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  2. Dennis McGonagle
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  3. Anne Bruns
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  4. Sandra Philipp
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  5. Sandra Hermann
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  6. Karlfried Aupperle
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  7. Ai Lyn Tan
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  8. Torsten Diekhoff
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  9. Bernd Hamm
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  10. Kay-Geert A. Hermann
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Correspondence to Kay-Geert A. Hermann.

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Braum, L.S., McGonagle, D., Bruns, A. et al. Characterisation of hand small joints arthropathy using high-resolution MRI—Limited discrimination between osteoarthritis and psoriatic arthritis. Eur Radiol 23, 1686–1693 (2013). https://doi.org/10.1007/s00330-012-2739-0

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  • DOI: https://doi.org/10.1007/s00330-012-2739-0

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