RESEARCH - MRI evidence of tendinopathy in early RA predicts tendon rupture at six years

January 9, 2007

Arthritis Rheum. 2005 Mar;52(3):744-51.

Magnetic resonance imaging evidence of tendinopathy in early rheumatoid

arthritis predicts tendon rupture at six years.

University of Auckland and Auckland District Health Board, Auckland, New

Zealand. f.mcqueen@... <f.mcqueen@...>

OBJECTIVE: To determine whether magnetic resonance imaging (MRI) evidence of

tendinopathy in early rheumatoid arthritis (RA) could be used to predict the

course of tendon involvement in later disease and specifically the risk of

tendon rupture. METHODS: The occurrence, pattern, and progression of

tendinopathy were studied prospectively over 6 years in a cohort of patients

who had presented with RA. Of 42 patients enrolled, full MRI and clinical

data were available for 31 at 6 years. MRI scans of the dominant wrist were

scored for tendinopathy by 2 radiologists using a validated system. These

data were compared with MRI synovitis, erosion scores, and disease activity

measures. Prognostic factors for tendon inflammation and rupture were

sought. RESULTS: Thirty-four patients (81%) had MRI evidence of tendinopathy

at baseline, falling to 59% at 1 year and 68% at 6 years. The most commonly

affected site was the extensor carpi ulnaris. MRI tendinopathy and synovitis

scores were correlated at baseline (r = 0.37, P = 0.01) and 1 year (r =

0.45, P = 0.003) but not at 6 years (r = 0.11, P = 0.5). The strongest

predictor of the 6-year tendinopathy score was the 1-year tendinopathy score

(R(2) = 0.36, P = 0.0003 [beta = 1.28, SE = 0.31]). In 4 patients, extensor

tendon rupture had occurred by 6 years. Their baseline and 1-year

tendinopathy scores were higher than in the nonrupture group (medians 2.8

versus 1.0 [P = 0.04] and 4.3 versus 0.8 [P = 0.03], respectively), as were

their Health Assessment Questionnaire scores (1.33 versus 0.54 [P = 0.02],

1.18 versus 0.25 [P = 0.03], and 0.98 versus 0.37 [P = 0.01] at 0, 1, and 6

years, respectively). For the group as a whole, the baseline tendinopathy

score was predictive of rupture at 6 years (odds ratio [OR] 1.52, 95%

confidence interval [95% CI] 1.02-2.32, P = 0.03), as was the 1-year score

(OR 1.57, 95% CI 1.03-2.04, P = 0.02).

CONCLUSION: MRI can be used to

quantify tendinopathy at the wrist in RA patients. High scores in early

disease were predictive of tendon rupture in a small group of patients, but

further studies are required to determine whether this has clinical

relevance.

PMID: 15751075

ctPlus & list_uids=15751075

Not an MD

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