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Department of
Molecular Medicine, Auckland School of Medicine, Auckland University,
Auckland, New Zealand.
Correspondence to: Dr F McQueen, Department of Molecular Medicine, Auckland School of Medicine, Auckland University, Private Bag 92019, Auckland, New Zealand.
Accepted for publication 9 December 1998
OBJECTIVES
To
investigate the progression of joint damage in early rheumatoid
arthritis (RA) using magnetic resonance imaging (MRI) of the wrist and
determine whether this technique can be used to predict prognosis.
METHODSAn inception
cohort of 42 early patients has been followed up prospectively for one
year. Gadolinium enhanced MRI scans of the dominant wrist were obtained
at baseline and one year and scored for synovitis, tendonitis, bone
marrow oedema, and erosions. Plain radiographs were performed
concurrently and scored for erosions. Patients were assessed clinically
for disease activity and HLA-DRB1 genotyping was performed.
RESULTSAt one year,
MRI erosions were found in 74% of patients (31 of 42) compared with
45% at baseline. Twelve patients (28.6%) had radiographic erosions at
one year. The total MRI score and MRI erosion score increased
significantly from baseline to one year despite falls in clinical
measures of inflammation including erythrocyte sedimentation rate
(ESR), C reactive protein (CRP), and swollen joint count (p < 0.01 for
all). Baseline findings that predicted carpal MRI erosions at one year
included a total MRI score of 6 or greater (sensitivity: 93.3%,
specificity 81.8%, positive predictive value 93.3%, p = 0.000007),
MRI bone oedema (OR = 6.47, p < 0.001), MRI synovitis (OR = 2.14, p = 0.003), and pain score (p = 0.01). Radiological erosions at one year
were predicted by a total MRI score at baseline of greater than 13 (OR = 12.4, p = 0.002), the presence of MRI erosions (OR = 11.6, p = 0.005), and the ESR (p = 0.02). If MRI erosions were absent at baseline
and the total MRI score was low, radiological erosions were highly
unlikely to develop by one year (negative predictive value 0.91 and
0.92 respectively). No association was found between the shared epitope
and erosions on MRI (p = 0.4) or radiography (p = 1.0) at one year.
CONCLUSIONSMRI scans
of the dominant wrist are useful in predicting MRI and radiological
erosions in early RA and may indicate the patients that should be
managed aggressively. Discordance has been demonstrated between
clinical improvement and progression of MRI erosion scores.
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