RESEARCH - MRI findings in 84 patients with early RA: bone marrow edema predicts erosive progression

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Published Online First: 2 November 2007. doi:10.1136/ard.2007.071977

ls of the Rheumatic Diseases 2008;67:794-800

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EXTENDED REPORTS

Magnetic resonance imaging findings in 84 patients with early

rheumatoid arthritis: bone marrow oedema predicts erosive progression

E A Haavardsholm 1,2, P Bøyesen 1,2, M Østergaard 3, A Schildvold 4, T

K Kvien 1,2

1 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

2 Faculty of Medicine, University of Oslo, Norway

3 Department of Rheumatology, Copenhagen University Hospitals at

Hvidovre and Herlev, Copenhagen, Denmark

4 Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway

Objectives: To examine the spectrum and severity of magnetic resonance

imaging (MRI) findings in patients with early rheumatoid arthritis

(RA), and to investigate the predictive value of MRI findings for

subsequent development of conventional radiographic (CR) damage and

MRI erosions.

Methods: 84 consecutive patients with RA with disease duration <1 year

were enrolled. Patients were treated according to standard clinical

practice, and evaluated at baseline, 3, 6 and 12 months by core

measures of disease activity, conventional radiographs of both hands

and wrists and MRI of the dominant wrist. MR images were scored

according to the OMERACT rheumatoid arthritis magnetic resonance

imaging score (RAMRIS), and conventional radiographs according to the

van der Heijde modified Sharp score.

Results: MRI findings reflecting inflammation (synovitis, bone marrow

oedema and tenosynovitis) decreased during follow-up, while there was

a small increase in MRI erosion score and CR damage. The proportion of

patients with erosive progression at 1 year was 48% for conventional

radiography and 66% for MRI. Baseline MRI bone marrow oedema (score >2

RAMRIS units) was identified as an independent predictor of both CR

(odds ratio = 2.77 (95% confidence interval (CI) 1.06 to 7.21)) and

MRI erosive progression (B = 0.21 (95% CI 0.08 to 0.34)).

Conclusions: MRI findings were common in early RA, and MRI bone marrow

oedema was an independent predictor of radiographic damage. These

results suggest that MRI scans of the dominant wrist may help

clinicians to determine which patients need early and aggressive

treatment to avoid subsequent joint damage.

http://ard.bmj.com/cgi/content/abstract/67/6/794?etoc

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