RESEARCH - MRI and bone scintigraphy in the differential diagnosis of unclassified arthritis

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Ann Rheum Dis. 2008 Jan;67(1):48-51. Epub 2007 Feb 8.

Magnetic resonance imaging and bone scintigraphy in the differential

diagnosis of unclassified arthritis.

Duer A, Østergaard M, Hørslev-sen K, Vallø J.

Department of Rheumatology, Copenhagen University Hospital at Hvidovre,

Copenhagen, Denmark.

OBJECTIVES: To investigate the value in clinical practice of hand magnetic

resonance imaging (MRI) and whole body bone scintigraphy in the differential

diagnosis of patients with unclassified arthritis. METHODS: 41 patients with

arthritis (> or = 2 swollen joints, > 6 months' duration) which remained

unclassified despite conventional clinical, biochemical and radiographic

(hands and feet) examinations were studied. Patients who fulfilled the ACR

criteria for rheumatoid arthritis (RA) or had radiographic bone erosions

were excluded. Contrast enhanced MRI of the wrist and metacarpophalangeal

joints of the most symptomatic hand and whole body bone scintigraphy were

performed. Two rheumatologists agreed on the most likely diagnosis and the

patients were treated accordingly. A final diagnosis was made by another

specialist review 2 years later. RESULTS: Tentative diagnoses after MRI and

bone scintigraphy were: RA (n = 13), osteoarthritis (n = 8), other

inflammatory diseases (n = 11), arthralgias without inflammatory or

degenerative origin (n = 9). Two years later 11 of 13 patients with an

original tentative diagnosis of RA had fulfilled the ACR criteria while two

were reclassified (one to psoriatic arthritis (RF negative + psoriasis); one

to non-specific self-limiting arthritis). No patients classified as non-RA

at baseline had fulfilled the ACR criteria after 2 years. The presence of

MRI synovitis, MRI erosion and bone scintigraphic pattern compatible with RA

showed 100% specificity for a diagnosis of RA at 2 year follow-up.

CONCLUSIONS: In patients with arthritis unclassified despite conventional

clinical, biochemical and radiographic examinations, MRI and scintigraphy

allowed correct classification as RA or non-RA in 39 of 41 patients when

fulfilment of ACR criteria 2 years later was considered the standard

reference.

PMID: 17289759

<http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=1

7289759>

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