RESEARCH - MRI of the hand for the diagnosis of RA in the absence of anti-CCP

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J Rheumatol. 2006 Jul 1; [Epub ahead of print]

Magnetic Resonance Imaging of the Hand for the Diagnosis of Rheumatoid

Arthritis in the Absence of Anti-Cyclic Citrullinated Peptide Antibodies: A

Prospective Study.

Solau-Gervais E, Legrand JL, Cortet B, Duquesnoy B, Flipo RM.

OBJECTIVE: To assess the practical usefulness of magnetic resonance imaging

(MRI) in establishing a positive diagnosis of rheumatoid arthritis (RA) in a

cohort of patients with early inflammatory polyarthralgia, in the absence of

anti-cyclic citrullinated peptide (anti-CCP) antibodies. METHODS: We

prospectively followed 30 outpatients with inflammatory polyarthralgia

and/or synovitis of at least one joint. Patients were disease modifying

antirheumatic drug-naive and received no corticosteroids. At the initial

visit a clinical examination, radiographs of hands, wrists and feet, and MRI

of hands were performed. Rheumatoid factor and anti-CCP antibodies were

assessed. The MRI procedure was T1 fat saturation with gadolinium injection

[scores were established on the basis of the axial view of the carpal and

metacarpal joints, using the RA MRI scoring system (RAMRIS) defined in the

OMERACT study]. In all patients, radiographs at baseline were normal and

anti-CCP antibodies were negative. RESULTS: At one-year followup, the final

diagnosis was: 16 RA; the non-RA group was composed of 4 cases of

spondyloarthropathy, 2 cases of fibromyalgia, 4 cases of undifferentiated

arthritis (3 of which were self-limiting), 1 sicca syndrome, 1

hemochromatosis, 1 polymyositis, and 1 paraneoplastic syndrome. No

statistical difference was found between patients with and without RA for

carpal erosion, synovitis, and tenosynovitis. However, a statistical

difference was observed between the RA and non-RA group where

metacarpophalangeal (MCP) erosion scores were concerned (p = 0.024). This

difference persisted when we compared erosions of the second and third MCP

in the 2 groups (p = 0.044). ROC curve analysis revealed a positive MCP

score at 15, with a specificity of 70% and a sensitivity of 64%.

CONCLUSION: In our population of 30 anti-CCP negative patients with normal

radiographs, MRI of hands, showing MCP erosions, can be helpful for the

diagnosis of RA.

PMID: 16832852

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6832852

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