[Radiological imaging in early diagnosis of rheumatoid arthritis. The role of ultrasound and magnetic resonance imaging]

A diffuse granulomatous inflammation secondary to a trauma of hand: a case report

Granulomatous inflammation is rare in the musculoskeletal system and difficult to diagnose. Here we describe a case of a 62-year-old woman with a history of being stabbed by a fishbone presented with a soreness, swelling, and limitation of movement of her right palm and wrist for 4 months. Surgery was done and the histopathology of specimens demonstrated granulomatous lesion, which was negative for acid-fast bacilli. This case demonstrates the diagnosis of granulomatous tenosynovitis on MRI, ultrasound, and surgical examination under anesthesia.

Grading of Ultrasonography in Rheumatoid Arthritis of Wrist and Hand Joints

RATIONALE AND OBJECTIVES

To evaluate the role of musculoskeletal ultrasound (MSUS) in the grading of rheumatoid arthritis (RA) wrist and hand joints and correlate it with clinical, laboratory, and radiological data.

MATERIALS AND METHODS

A cross-sectional study recruited 50 patients in a tertiary care hospital. RA activity was assessed by DAS28. MSUS dorsal longitudinal scan was performed on the wrists, MCPs, and PIPS joints using high frequency (18 MHZ) linear transducer. 100 wrists in three different views, 500 MCPs, 500 PIPs were evaluated using the grayscale ultrasound and power Doppler ultrasound semiquantitative scale and scores ranging from 0-3. The results were correlated with clinical, laboratory and radiological data. All patients' wrist and hand joints X-rays were evaluated using the Larsen score.

RESULTS

The mean age of the patients (49 females and one male) was 44.58 ± 10.07 years, and their mean disease duration was 16.26 ± 1.07 years. The mean DAS28 was 5.19 ± 0.95. 97.5% of joints had grade I Larsen score, 11.07% of the joints had erosions, 9.2% of the joints had effusions, 23.8% of the joints had synovial thickening, 11.9% of the joints showed PD signals and 3.5% of the joints were accompanied with tenosynovitis. Significant relations (p < 0.05) found among DAS28 and (PD signals, synovial thickening, tenosynovitis, effusion, and Larsen score). A nonsignificant relation (p > 0.05) among DAS28 and erosions detected by MSUS and X-ray.

CONCLUSION

MSUS is powerful in the detection of early RA regarding synovitis, joint effusion, tenosynovitis, and bone erosions, which were correlated with clinical and laboratory parameters.

Early extremity MRI findings and pathological synovial changes in antigen-induced arthritis rabbit model

PURPOSE

To investigate the association between early extremity MRI (E-MRI) findings and synovial pathological changes in antigen-induced arthritis (AIA) rabbit model.

MATERIALS AND METHODS

AIA was successfully induced in the right knee of 32 sensitized Japanese white rabbits, which were then divided into four groups according to the time of killing after AIA induction: 1-week (Group A), 2-weeks (Group B), 3-weeks (Group C), and 4-weeks (Group D); the left knee served as control in each rabbit.

RESULTS

There were varying degrees of joint effusion in all AIA groups. E-MRI scan showed low signal in T1-weighted images (T1Wi) and high signal in T2-weighted images (T2Wi). Enhanced E-MRI revealed elevated synovial signal at the right knee in the three-dimensional spoiled gradient T1WI, showing linear and band-shaped, diffuse hyperintensity. Histological examination of right knees found scattered inflammatory cell infiltration, swelling, and proliferation of the synovial cells at 7 days after AIA induction and dispersed and disordered proliferation of synovial cells up to 3 layers at 28 days postinduction. The synovial enhancement of right knee E-MRI was consistent with a synovial pathology score for all rabbits (Kappa = 0.965, P < 0.01).

CONCLUSION

E-MRI can reveal the degree of changes in the joints and synovium at different periods of the AIA model.