MRIs of healthy subjects occasionally show changes resembling erosions and synovitis as seen in RA

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Arthritis & Rheumatism

Volume 50, Issue 4 , Pages 1097 - 1106

Published Online: 5 Apr 2004

Magnetic resonance imaging of wrist and finger joints in healthy

subjects occasionally shows changes resembling erosions and synovitis as

seen in rheumatoid arthritis

Bo Ejbjerg 1 *, Eva Narvestad 1, Egill Rostrup 1, Marcin

Szkudlarek 1, Søren sen 2, Henrik S. Thomsen 3, Mikkel Østergaard 4

5

1Copenhagen University Hospital at Hvidovre, Hvidovre, Denmark

2Copenhagen University Hospital at Bispebjerg, Bispebjerg, Denmark

3Copenhagen University Hospital at Herlev, Herlev, Denmark

4Copenhagen University Hospital at Hvidovre, Hvidovre, Denmark

5Copenhagen University Hospital at Herlev, Herlev, Denmark

email: Bo Ejbjerg (ejbjerg@...)

*Correspondence to Bo Ejbjerg, Department of Rheumatology, Copenhagen

University Hospital at Hvidovre, Kettegaard Allé 30, 2650 Hvidovre,

Denmark

Abstract

Objective

To explore the presence of changes resembling rheumatoid arthritis

erosions and synovitis in metacarpophalangeal (MCP) and wrist joints of

healthy individuals on magnetic resonance imaging (MRI) and to compare

the MRI findings with conventional radiographic, clinical, and

biochemical findings.

Methods

Twenty-eight healthy individuals were studied. Contrast-enhanced

MRI and conventional radiography of the dominant wrist and second

through fifth MCP joints were performed, coupled with standard clinical

assessments and biochemical analyses. MR images were evaluated according

to the latest OMERACT (Outcome Measures in Rheumatology Clinical Trials)

recommendations with respect to synovitis, erosions, and bone marrow

edema.

Results

Conventional radiography revealed erosion-like changes in 1 of 224

MCP joint bones (0.4%) and in 1 of 420 wrist joint bones (0.2%). MRI

depicted low-grade erosion-like changes in 5 of 224 MCP joint bones

(2.2%) and in 7 of 420 wrist joint bones (1.7%), but postcontrast

enhancement within the lesion was detected in only 8.3% of these. MRI

depicted low-grade synovitis-like changes in 10 of 112 MCP joints (8.9%)

and in 8 of 84 assessed wrist areas (9.5%), while only minimal early

synovial enhancement was detected by dynamic MRI. Three subjects had

elevated serum levels of C-reactive protein, and these subjects

displayed 44.5% of the synovitis-like changes and 41.7% of the

erosion-like changes. Bone marrow edema-like changes were not found in

any joints.

Conclusion

Changes resembling mild synovitis or small bone erosions are

occasionally found in the MCP and wrist joints of healthy controls.

Signs of synovitis on dynamic MRI, enhancement within bone erosion-like

changes, and signs of bone marrow edema appear rarely or are absent in

healthy controls. These signs may thus prove to be very specific in the

distinction between arthritic and normal joints.

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