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Department of Molecular Medicine, Auckland School of
Medicine, Auckland University, Private Bag 92019, Auckland, New Zealand
Correspondence to: Dr F McQueen.
Accepted for publication 29 April 1998
OBJECTIVES
To evaluate the role of magnetic
resonance imaging (MRI) of the wrist in detecting early joint damage in
patients with rheumatoid arthritis (RA).
METHODSMRI was performed on 42 patients with
early RA (median symptom duration of four months). Scans were scored
separately by two musculoskeletal radiologists using a newly devised
scoring system, which was validated. MRI findings were compared with
plain radiography, clinical measures, and HLA-DRB*01/04 genotyping.
RESULTSInterobserver reliability for the overall
MRI score was high (r = 0.81) as was intraobserver
reliability (r = 0.94 for observer 1 and 0.81 for observer
2). There was more variation in scoring synovitis (interobserver
reliability: r = 0.74). Erosions were detected in 45% of
scans (19 of 42), compared with 15% of plain radiographs. The most
common site for erosions was the capitate (39%), for synovitis the
ulnar aspect of the radiocarpal joint, and for tendonitis, the extensor
carpi ulnaris tendon. The total MRI score and MRI synovitis score
correlated most significantly with C reactive protein (r = 0.40 and 0.42 respectively, p<0.01). The MRI erosion score was highly
correlated with MRI bone marrow oedema (r = 0.83) as well
as the Ritchie score and disease activity score (r = 0.32, p<0.05). HLA-DRB1*04 or *01 (shared epitope +ve) was found in 76% of
patients; 84% of those with MRI erosions and 69% of those without
(NS, p = 0.3).
CONCLUSIONSA high proportion of RA patients
develop MRI erosions very early in their disease, when plain
radiography is frequently normal. MRI of the dominant wrist may
identify those requiring early aggressive treatment.
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