Diagnostic value of MRI of the forefeet in early RA when findings on imaging of the MCP joints of the hands remain normal

[Guest guest]

Arthritis Rheum. 2004 Jul;50(7):2094-102.

Diagnostic value of magnetic resonance imaging of the forefeet in early

rheumatoid arthritis when findings on imaging of the metacarpophalangeal

joints of the hands remain normal.

Ostendorf B, Scherer A, Modder U, Schneider M.

Heinrich-Heine University of Duesseldorf, Duesseldorf, Germany.

OBJECTIVE: To investigate the diagnostic role of magnetic resonance

imaging (MRI) of the forefeet in patients with early rheumatoid

arthritis (RA) in whom findings on MR images of the hands are normal and

conventional radiographs of the hands and feet do not show erosions.

METHODS: The study group comprised 25 patients with early RA (disease

duration of <12 months) in whom erosions were not demonstrated on

conventional radiographs of the hands and feet. These patients underwent

MRI of the clinically dominant hand to detect signs of arthritis. If

results of MRI of the hand were normal according to the Outcome Measures

in Rheumatology Clinical Trials (OMERACT) RA-MRI scoring system

(RAMRIS), MRI of the dominant forefoot was performed. The MRI protocol

comprised coronal and sagittal T1-weighted spin-echo (before and after

administration of contrast medium), coronal fat-suppressed short tau

inversion recovery sequences, coronal and sagittal T2-weighted turbo

spin-echo sequences, and axial fat-suppressed T1-weighted spin-echo

sequences after administration of contrast medium. MRI of the forefeet

was analyzed on the basis of a modified RAMRIS. RESULTS: MRI revealed

pathologic findings in the hands of 15 of 25 patients (edema in 9

patients, synovitis in 12, erosions in 6, defects in 3). In 10 patients

with a mean disease duration of 9.4 weeks, hand MRI scans were normal

according to RAMRIS. Four of these 10 patients had tenosynovitis of the

finger flexor tendons (there was no OMERACT criterion for

tenosynovitis). RAMRIS analysis of the corresponding MRI scans of the

forefeet of these patients revealed signs of edema in 7 patients,

synovitis in all 10 patients (at the third metatarsophalangeal [MTP]

joint in 7, at the fourth MTP joint in 6, at the first MTP joint in 4,

and at the fifth MTP joint in 2 patients), tenosynovitis of the foot

flexor tendons in 2 patients, erosions at the second and third MTP

joints in 1 patient, and a single defect at the first MTP joint in 1

patient.

CONCLUSION: RAMRIS analysis of MRI scans of the forefeet detected

synovitis and bone edema in patients with early RA in whom MRI of the

finger joints was normal. MRI of the forefeet contributes an additional

tool aimed at earlier and more accurate diagnosis and thus might allow

an earlier decision to start appropriate medication in patients with

early RA.

PMID: 15248206

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org