Periarticular Bone Findings in Rheumatoid Arthritis: T2-Weighted Versus Contrast-Enhanced T1-Weighted MRI

Diagnostic test accuracy of magnetic resonance imaging and ultrasound for detecting bone erosion in patients with rheumatoid arthritis

OBJECTIVE

To evaluate and compare the diagnostic test accuracy of magnetic resonance imaging (MRI) and ultrasound (US) for bone erosion in rheumatoid arthritis (RA) patients for a specific and efficient diagnostic recommendation.

METHOD

To evaluate the diagnostic accuracy, the sensitivity, specificity, area under the summary receiver operating characteristic curve, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of MRI and US for detecting bone erosion were calculated. Subgroup analyses were conducted to evaluate the performance of these values with different standard references when compared with types of machines and scanning positions.

RESULTS

Data from 26 articles were extracted for calculation. The comprehensive values of sensitivity and specificity were 0.77 (95% CI 0.63, 0.87)/0.89 (95% CI 0.80, 0.95) and 0.61 (95% CI 0.43, 0.77)/0.95 (95% CI 0.88, 0.98) for MRI and US, respectively. The 1.5-T Signa MRI system, General Electric© (sensitivity 0.66; specificity 0.90), and different models of LOGIQ US units and General Electric© (sensitivity 0.66; specificity 0.91) had better diagnostic capability to detect bone erosion, while the 2nd metacarpophalangeal joint (sensitivity 0.70; specificity 0.98) showed the best diagnostic performance among the hand joints with US.

CONCLUSIONS

Neither MRI nor US showed satisfactory diagnostic test accuracy in detecting bone erosion. However, the 1.5-T Signa MRI system, General Electric©, and different models of LOGIQ US units and General Electric© showed similarly good performance in detecting bone erosion in RA patients, while the 2nd metacarpophalangeal joint is the best recommended scanning position during US.

KEY POINTS

• In this study, we evaluated the diagnostic accuracy of US and MRI for bone erosion in RA patients, neither MRI nor US showed perfect diagnostic test accuracy.• 1.5-T Signa system and the LOGIQ units both from General Electric© are the machine types of MRI and US with the greatest performance, respectively.• The 2nd MCP joint is the scanning position recommended during US test.• Different reference standards will greatly influence the judgment of the results.

MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings

The management of patients with rheumatoid arthritis (RA) has rapidly evolved with the development of newer disease-modifying drugs and the recognition that long-term damage can be mitigated by an earlier and more-informed use of these medications. Historically, radiographs were the mainstay of imaging in RA patients, but radiographic joint narrowing and erosions are late and insensitive findings in the disease. MRI (with intravenous contrast agent) and ultrasound (with power Doppler interrogation) of the hands and wrists are able to demonstrate erosions earlier and with greater sensitivity than radiographs. More importantly, these imaging studies also depict synovitis and active soft-tissue inflammation, which represents a precursor to structural damage. Additionally, MRI can show inflammation within the bones (osteitis), which is proving to be the most important prognosticator of an aggressive disease course. Part I of this review discusses the imaging techniques, pitfalls, definitions, and comparative studies of MRI and ultrasound for identifying and quantifying erosions, synovitis, and osteitis. Part II will demonstrate how these imaging findings influence the clinical management of RA patients throughout their disease course, from presentation through clinical remission.

Baseline serum level of matrix metalloproteinase-3 as a biomarker of progressive joint damage in rheumatoid arthritis patients

AIM

Matrix metalloproteinase-3 (MMP-3) plays a pivotal role in the destruction of bone and degradation of cartilage components in rheumatoid arthritis (RA). We aimed in this study to analyze the relation between baseline levels of MMP-3 and the progression of joint damage in RA.

METHODS

Eighty-one untreated RA patients with joint symptoms for <1 year were evaluated at baseline and after 12 months as regards erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and plain X-ray of both hands and wrists. Baseline levels of MMP-3 were measured by enzyme-linked immunosorbent assay and magnetic resonance imaging (MRI) of hands/wrists was performed. Disease Activity Score (DAS28) and Health Assessment Questionnaire (HAQ) were performed at baseline evaluation and after 12 months.

RESULTS

The baseline MMP-3 levels were significantly higher in the high-progression group compared with the low-progression one (95.75 ± 42.84 vs. 50.45 ± 12.83, P < 0.001). There was a positive correlation between baseline levels of MMP-3 and MRI erosion score and other baseline clinical parameters, except for HAQ and the van der Heijde modification of the Sharp scoring system (SvdH) scores, while after 12 months, there were high positive correlations between MMP-3 and SvdH score, as well as all parameters except for ESR.

CONCLUSION

Serum baseline levels of MMP-3 are strong prognostic markers of disease activity, and act well as an early predictor of progressive joint damage in recent-onset RA disease.

Anatomic-functional (perfusion-based) magnetic resonance imaging follow-up in patients with rheumatoid arthritis treated with anti-interleukin 6 antibodies: a comparison with clinical scores and serologic data

OBJECTIVE

On a 3-T magnetic resonance scanner, morphologic and perfusion changes of 9 patients with rheumatoid arthritis were evaluated after start of anti-interleukin 6 receptor antibody Tocilizumab (TCZ) treatment.

METHODS

Morphologic and perfusion-based magnetic resonance imaging (MRI) parameters were assessed before and 4, 12, and 24 after the start of TCZ treatment. Furthermore, serologic biomarkers and clinical assessment scores were evaluated 4, 12, 24, and 52 weeks after treatment initiation.

RESULTS

Results of MRI parameters showed significant group differences between responders and nonresponders for synovial volume, transfer constant, and blood plasma volume fraction already at week 12 as well as relative enhancement and rate of early enhancement at week 24.

CONCLUSIONS

Considering the temporal change of perfusion-derived MRI parameters (transfer constant, blood plasma volume fraction, relative enhancement, and rate of early enhancement) as well as morphologic MRI parameters (synovial volume measurements), a quantifiable assessment of response to TCZ therapy in rheumatoid arthritis seems possible at an even earlier time point compared with clinical assessment scores, whereas serologic biomarkers proved nonspecific in this respect.

MR imaging assessment of inflammatory, crystalline-induced, and infectious arthritides

The role of magnetic resonance imaging in evaluating patients with inflammatory arthritides has evolved with the recent introduction of drugs capable of modifying disease activity and natural history. In conditions like rheumatoid arthritis, active synovitis and bone marrow inflammation precede and predict bone and cartilage erosion. These imaging findings identify patients who can be treated early and aggressively to prevent future morbidity. Similarly, in gout and other crystalline disorders, specific diagnosis aided by imaging may lead to earlier medical and surgical management. Infected joints need the most rapid identification to institute immediate therapy and prevent irreversible cartilage destruction.

Imaging in rheumatoid arthritis--status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography

Sensitive and reproducible tools for diagnosis, monitoring of disease activity and damage, and prognostication are essential in the management of patients with rheumatoid arthritis (RA). Conventional radiography (X-ray), the traditional gold standard for imaging in RA, is not able to detect early disease manifestations such as inflammatory changes in the soft tissues (synovitis, tensynovitis, enthesitis etc.) and the earliest stages of bone erosion. In contrast, magnetic resonance imaging (MRI) and ultrasonography (US) allow direct visualization of early inflammatory and destructive joint changes, and have several documented and potential applications in RA patients. This chapter will review key aspects of the current status and recent important advances in imaging in RA, briefly discussing X-ray and computed tomography, and particularly focusing on MRI and US. Suggestions for use in clinical trials and practice are provided.

Systemic AL amyloidosis mimicking rheumatoid arthritis

We report a patient with myeloma-associated systemic AL amyloidosis who showed chronic polyarthralgia as the main symptom. The clinical picture was similar to that of rheumatoid arthritis with regard to symmetrical swelling with tenderness in multiple joints, but inflammatory reactions were almost normal and autoantibodies were negative. He was diagnosed as having systemic AL amyloidosis based on deposition of kappa-light chain-immunoreactive amyloid in biopsied tissue and Bence Jones protein in serum and urine. Magnetic resonance imaging and bone scintigraphy suggested this disease as the cause of the polyarthralgia. Systemic AL amyloidosis may be important in the differential diagnosis of chronic polyarthralgia.

The role of magnetic resonance imaging in the early diagnosis of rheumatoid arthritis

Rheumatoid arthritis (RA) is a common disease that affects 1% of the population. With the advent of disease-modifying therapies, it became particularly important to detect RA as early as possible. In this article, we discuss the role of magnetic resonance imaging (MRI) in the imaging of early RA. Imaging of soft tissues manifestations, which precede the development of osseous erosions, is discussed. We also review the role of MRI in establishing correct diagnosis in cases of arthritis, which do not demonstrate classical clinical presentation. The role of MRI in the follow-up of RA is addressed.