Magnetic Resonance Imaging Bone Edema at Enrollment Predicts Rapid Radiographic Progression in Patients with Early RA: Results from the Nagasaki University Early Arthritis Cohort

2016 ◽  
Vol 43 (7) ◽  
pp. 1278-1284 ◽  
Author(s):  
Yoshikazu Nakashima ◽  
Mami Tamai ◽  
Junko Kita ◽  
Toru Michitsuji ◽  
Toshimasa Shimizu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Radiographic Progression ◽  
Bone Erosion ◽  
Early Stage ◽  
Early Arthritis ◽  
Resonance Imaging ◽  
Multivariate Logistic Regression ◽  
Bone Edema

Objective.To clarify whether magnetic resonance imaging (MRI) bone edema predicts the development of rapid radiographic progression (RRP) in the Nagasaki University Early Arthritis Cohort of patients with early-stage rheumatoid arthritis (RA).Methods.Patients with early-stage RA (n = 76) were enrolled and underwent 1.5-T MRI of both wrists and finger joints. Synovitis, bone edema, and bone erosion were evaluated using the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS). RRP was defined as an annual increment > 3 at 1 year by the Genant-modified Sharp score of plain radiographs. A multivariate logistic regression analysis was performed to establish the risk factors for RRP.Results.Median disease duration at enrollment was 3 months. RRP was found in 12 of the 76 patients at 1 year. A univariate analysis revealed that matrix metalloprotease-3, RAMRIS bone edema score, and RAMRIS bone erosion score were associated with RRP. Multivariate logistic regression analyses demonstrated that the RAMRIS bone edema score at enrollment (5-point increase, OR 2.18, 95% CI 1.32–3.59, p = 0.002) was the only independent predictor of the development of RRP at 1 year. A receiver-operating characteristic analysis identified the best cutoff value for RAMRIS bone edema score as 5. RRP was significantly rare among the patients with a RAMRIS bone edema score < 5 at enrollment (2 from 50 patients).Conclusion.Our findings suggest that MRI bone edema is closely associated with the development of RRP in patients with early-stage RA. Physicians should carefully control the disease activity when MRI bone edema is observed in patients with early RA.

Magnetic Resonance Imaging of the Rheumatic Foot According to the RAMRIS System Is Reliable

2011 ◽  
Vol 38 (6) ◽  
pp. 1003-1008 ◽  
Author(s):  
HENRIËTTE BAAN ◽  
ROLAND BEZOOIJEN ◽  
JOHANNES K.A. AVENARIUS ◽  
ROSEMARY DUBBELDAM ◽  
WIEPKE K. DROSSAERS-BAKKER ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Scoring System ◽  
Bone Erosion ◽  
Outcome Measurement ◽  
Random Sets ◽  
Resonance Imaging ◽  
Bone Edema ◽  
Magnetic Resonance Imaging Mri

Objective.In rheumatology, magnetic resonance imaging (MRI) is predominantly applied in the assessment and outcome measurement of rheumatoid arthritis (RA) in hands and wrists, leading to the development of the RAMRIS (RA-MRI-Scoring) system. It was initiated by the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT). The RAMRIS system has not been applied widely in the measurement of feet. We investigated the interreader and intrareader agreement of the RAMRIS scoring system in the assessment of feet in RA.Methods.Twenty-nine patients with RA who had radiological damage and/or arthritis underwent MRI. Two experienced readers independently read both complete sets. One reader read 6 random sets after the initial session, in order to assess the intrareader agreement. For evaluation of the intrareader and interreader reliability, quadratic-weighted κ scores were calculated per joint and lesion.Results.For the forefeet, interreader scores were excellent, ranging from 0.77 (bone edema) to 0.95 (bone erosion). Hindfoot interreader agreement scores were highest for erosion (0.90) and synovitis global score (0.88), but edema and synovial thickness agreement were also acceptable (0.83 and 0.86). Intrareader scores were on the whole slightly lower, but excellent.Conclusion.Reliability (interreader and intrareader agreement) in the assessment of the rheumatoid foot according to the RAMRIS method is excellent.

scholarly journals Magnetic Resonance Imaging of Bilateral Hands Is More Optimal Than MRI of Unilateral Hands for Rheumatoid Arthritis

2018 ◽  
Vol 45 (7) ◽  
pp. 895-904 ◽  
Author(s):  
Ying-Qian Mo ◽  
Ze-Hong Yang ◽  
Hai-Ning He ◽  
Jian-Da Ma ◽  
Jin-Jian Liang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Linear Models ◽  
Bone Erosion ◽  
Metacarpophalangeal Joint ◽  
Whole Body ◽  
Resonance Imaging ◽  
Mri Features ◽  
Scatter Plots

Objective.To explore the advantages of magnetic resonance imaging (MRI) of bilateral hands in rheumatoid arthritis (RA).Methods.Consecutive patients with active RA were recruited for clinical assessments, radiographs, and MRI of bilateral hands. Bilateral hands were scanned simultaneously on 3.0 T whole-body MRI system and were scored on synovitis, osteitis, and bone erosion according to the RA MRI scoring (RAMRIS) system.Results.Among 120 patients included, wrist bones and metacarpophalangeal joint (MCPJ) 2 proximal showed bone erosion in early RA. The second to fifth metacarpal bases and the second to fourth MCPJ distal showed more bone erosion in mid-stage or late-stage RA. When MRI of dominant unilateral hand was analyzed, MRI synovitis and osteitis in 5% of wrists and 3 MRI features in 5–14% of MCPJ were misdiagnosed (McNemar test, all p < 0.05). There were 46% wrist synovitis, 29–52% MCPJ2–5 synovitis, 45% wrist osteitis, and 20%–34% MCPJ2–5 osteitis not detected by joint tenderness and/or swelling. When the clinically more severe hand was selected for MRI of unilateral hand according to physical examination, MRI synovitis in 5% of wrists and 3 MRI features in 7–15% of MCPJ were misdiagnosed (all p < 0.05). Scatter plots and linear regression analyses were used to illustrate RAMRIS between dominant or selected hand (Y values) and nondominant or nonselected hand (X values). All linear models were markedly different from a Y = X linear model, indicating the dominant or clinically more severe hand could not represent the contralateral hand to evaluate RAMRIS.Conclusion.MRI of bilateral hands is more optimal than MRI of the unilateral hand in RA.

scholarly journals The Relationship Between Synovial Pathobiology and Magnetic Resonance Imaging Abnormalities in Rheumatoid Arthritis: A Systematic Review

2017 ◽  
Vol 44 (9) ◽  
pp. 1311-1324 ◽  
Author(s):  
Frances Humby ◽  
Arti Mahto ◽  
Muaaze Ahmed ◽  
Andrew Barr ◽  
Stephen Kelly ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Bone Erosion ◽  
Critical Role ◽  
Joint Damage ◽  
Resonance Imaging ◽  
The Relationship

Objective.Magnetic resonance imaging (MRI) has been increasingly recognized as a critical tool for the assessment of patients with rheumatoid arthritis (RA) and is able to reliably identify synovitis, bone marrow edema, bone erosion, and joint space narrowing (JSN)/cartilage loss. Understanding the exact relationship between each MRI feature and local synovial pathobiology is critical to dissect disease pathogenesis as well as develop future predictive models.Methods.A systematic review was performed of the current published literature examining the relationship between MRI abnormalities and synovial pathobiology in patients with RA.Results.Eighteen studies were identified; most focused on validation of MRI as a tool to detect and quantify synovitis, with a significant relationship demonstrated. Additionally, from the limited data available, a critical role seems likely for synovial pathways, at least in driving joint damage. However, there was a lack of data examining the relationship between synovial pathobiology and bone marrow abnormalities and JSN.Conclusion.Although understanding the interrelationship of these disease biomarkers offers the potential to enhance the predictive validity of modern imaging with concomitant synovial pathobiological analysis, further studies integrating MRI with synovial tissue analysis in well-controlled cohorts at distinct disease stages before and after therapeutic intervention are required to achieve this.

Validation of the OMERACT Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) for the Hand and Foot in a Randomized Placebo-controlled Trial

2015 ◽  
Vol 42 (12) ◽  
pp. 2473-2479 ◽  
Author(s):  
Daniel Glinatsi ◽  
Paul Bird ◽  
Frederique Gandjbakhch ◽  
Philip J. Mease ◽  
Pernille Bøyesen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Psoriatic Arthritis ◽  
Magnetic Resonance ◽  
Bone Erosion ◽  
Controlled Trial ◽  
Intraclass Correlation ◽  
Resonance Imaging ◽  
Bone Edema ◽  
Hands And Feet ◽  
Bone Proliferation

Objective.To assess changes following treatment and the reliability and responsiveness to change of the Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) in a randomized controlled trial.Methods.Forty patients with PsA randomized to either placebo or abatacept (ABA) had MRI of either 1 hand (n = 20) or 1 foot (n = 20) at baseline and after 6 months. Images were scored blindly twice by 3 independent readers according to the PsAMRIS (for synovitis, tenosynovitis, periarticular inflammation, bone edema, bone erosion, and bone proliferation).Results.Inflammatory features improved numerically but statistically nonsignificantly in the ABA group but not the placebo group. Baseline intrareader intraclass correlation coefficients (ICC) were good (≥ 0.50) to very good (≥ 0.80) for all features in both hand and foot. Baseline interreader ICC were good (ICC 0.72–0.96) for all features, except periarticular inflammation and bone proliferation in the hand and tenosynovitis in the foot (ICC 0.25–0.44). Intrareader and interreader ICC for change scores varied. Guyatt’s responsiveness index (GRI) was high for inflammatory features in the hand and metatarsophalangeal joints (GRI −0.67 to −3.13; bone edema not calculable). Minimal change and low prevalence resulted in low ICC and GRI for bone damage.Conclusion.PsAMRIS showed overall good intrareader agreement in the hand and foot, and inflammatory feature scores were responsive to change, suggesting that PsAMRIS may be a valid tool for MRI assessment of hands and feet in PsA clinical trials.

Determining a Magnetic Resonance Imaging Inflammatory Activity Acceptable State Without Subsequent Radiographic Progression in Rheumatoid Arthritis: Results from a Followup MRI Study of 254 Patients in Clinical Remission or Low Disease Activity

2013 ◽  
Vol 41 (2) ◽  
pp. 398-406 ◽  
Author(s):  
Frédérique Gandjbakhch ◽  
Espen A. Haavardsholm ◽  
Philip G. Conaghan ◽  
Bo Ejbjerg ◽  
Violaine Foltz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Clinical Remission ◽  
Radiographic Progression ◽  
Inflammatory Activity ◽  
Resonance Imaging ◽  
Low Disease Activity ◽  
Synovitis Score

Objective.To assess the predictive value of magnetic resonance imaging (MRI)-detected subclinical inflammation for subsequent radiographic progression in a longitudinal study of patients with rheumatoid arthritis (RA) in clinical remission or low disease activity (LDA), and to determine cutoffs for an MRI inflammatory activity acceptable state in RA in which radiographic progression rarely occurs.Methods.Patients with RA in clinical remission [28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6, n = 185] or LDA state (2.6 ≤ DAS28-CRP < 3.2, n = 69) with longitudinal MRI and radiographic data were included from 5 cohorts (4 international centers). MRI were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS). Statistical analyses included an underlying conditional logistic regression model stratified per cohort, with radiographic progression as dependent variable.Results.A total of 254 patients were included in the multivariate analyses. At baseline, synovitis was observed in 95% and osteitis in 49% of patients. Radiographic progression was observed in 60 patients (24%). RAMRIS synovitis was the only independent predictive factor in multivariate analysis. ROC analysis identified a cutoff value for baseline RAMRIS synovitis score of 5 (maximum possible score 21). Rheumatoid factor (RF) status yielded a significant interaction with synovitis (p value = 0.044). RF-positive patients with a RAMRIS synovitis score of > 5 vs ≤ 5, had an OR of 4.4 (95% CI 1.72–11.4) for radiographic progression.Conclusion.High MRI synovitis score predicts radiographic progression in patients in clinical remission/LDA. A cutoff point for determining an MRI inflammatory activity acceptable state based on the RAMRIS synovitis score was established. Incorporating MRI in future remission criteria should be considered.

Nail Disease in Psoriatic Arthritis: Distal Phalangeal Bone Edema Detected by Magnetic Resonance Imaging Predicts Development of Onycholysis and Hyperkeratosis

2012 ◽  
Vol 39 (4) ◽  
pp. 841-843 ◽  
Author(s):  
NICOLA DALBETH ◽  
KAREN PUI ◽  
MARIA LOBO ◽  
ANTHONY DOYLE ◽  
PETER B. JONES ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Psoriatic Arthritis ◽  
Magnetic Resonance ◽  
Bone Erosion ◽  
Resonance Imaging ◽  
Mri Features ◽  
Bone Edema ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Nail Disease

Objective.To examine the association between magnetic resonance imaging (MRI) features of distal phalanx (DP) disease and the progression of nail pathology in psoriatic arthritis (PsA).Methods.Clinical nail assessment and hand MRI scans were done on 34 patients with PsA. Twenty patients had repeat nail assessments after 1 year.Results.Nails with onycholysis and hyperkeratosis at baseline were more likely to have corresponding DP bone erosion and proliferation on MRI. DP bone edema on baseline MRI was associated with development of onycholysis and hyperkeratosis in corresponding nails.Conclusion.Our data suggest that DP inflammation is central in the development of psoriatic nail disease.

Are Rheumatoid Arthritis Patients Discernible from Other Early Arthritis Patients Using 1.5T Extremity Magnetic Resonance Imaging? A Large Cross-sectional Study

2014 ◽  
Vol 41 (8) ◽  
pp. 1630-1637 ◽  
Author(s):  
Wouter Stomp ◽  
Annemarie Krabben ◽  
Désirée van der Heijde ◽  
Tom W.J. Huizinga ◽  
Johan L. Bloem ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cross Sectional Study ◽  
Early Arthritis ◽  
Symptom Duration ◽  
Sectional Study ◽  
Resonance Imaging ◽  
Cross Sectional ◽  
Mri Features

Objective.Magnetic resonance imaging (MRI) is increasingly used in rheumatoid arthritis (RA) research. A European League Against Rheumatism (EULAR) task force recently suggested that MRI can improve the certainty of RA diagnosis. Because this recommendation may reflect a tendency to use MRI in daily practice, thorough studies on the value of MRI are required. Thus far no large studies have evaluated the accuracy of MRI to differentiate early RA from other patients with early arthritis. We performed a large cross-sectional study to determine whether patients who are clinically classified with RA differ in MRI features compared to patients with other diagnoses.Methods.In our study, 179 patients presenting with early arthritis (median symptom duration 15.4 weeks) underwent 1.5T extremity MRI of unilateral wrist, metacarpophalangeal, and metatarsophalangeal joints according to our arthritis protocol, the foot without contrast. Images were scored according to OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) by 2 independent readers. Tenosynovitis was also assessed. The main outcome was fulfilling the 1987 American College of Rheumatology (ACR) criteria for RA. Test characteristics and areas under the receiver-operator-characteristic curves (AUC) were evaluated. In subanalyses, the 2010 ACR/EULAR criteria were used as outcome, and analyses were stratified for anticitrullinated protein antibodies (ACPA).Results.The ACR 1987 criteria were fulfilled in 43 patients (24.0%). Patients with RA had higher scores for synovitis, tenosynovitis, and bone marrow edema (BME) than patients without RA (p < 0.05). ACPA-positive patients had more BME (median scores 6.5 vs. 4.25, p = 0.016) than ACPA-negative patients. For all MRI features, the predictive value for the presence of RA was low (< 50%). For all MRI features the AUC were < 0.70. Patients who fulfilled ACR/EULAR 2010 criteria but not ACR87 criteria for RA had less synovitis than patients who were positive for RA according to both sets of criteria (p = 0.029).Conclusion.Although patients with RA had higher scores of MRI inflammation and ACPA-positive patients had more BME, the severity of MRI inflammation assessed according to RAMRIS does not accurately differentiate patients with RA from other early arthritis patients.

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