RESEARCH - Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of RA

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Rheumatology Advance Access originally published online on May 27, 2009

Rheumatology 2009 48(8):887-891; doi:10.1093/rheumatology/kep136

Tenosynovitis of the flexor tendons of the hand detected by MRI: an

early indicator of rheumatoid arthritis

Iris Eshed1, Eugen Feist2, Christian E. Althoff3, Bernd Hamm3, Eli

Konen1, Gerd-R. Burmester2, Marina Backhaus2 and Kay-Geert A. Hermann3

1Department of Radiology, Sheba Medical Center, Tel Hashomer, Sackler

School of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Department

of Rheumatology and Clinical Immunology and 3Department of Radiology,

Charité Medical School, Berlin, Germany.

Abstract

Objective. To evaluate the potential of MRI of finger and wrist joints

for diagnosing early RA. MRI was evaluated as a stand-alone tool and

in combination with ACR criteria and serum markers such as RF.

Methods. Ninety-nine patients (31 men, 68 women; median age 46 years)

with unspecified arthritis or suspected RA and negative X-ray findings

were included. MR images of the hand and wrist of these patients were

retrospectively evaluated for the presence of synovitis, erosions and

tenosynovitis. The clinical diagnosis (early RA or non-RA) was made by

a rheumatologist after clinical follow-up for 6–41 months. Clinical

and laboratory data were collected from all patients.

Results. Fifty-eight patients had a clinical diagnosis of RA and 41

were diagnosed as non-RA. Step-wise logistic regression of all MR

parameters evaluated identified tenosynovitis of the flexor tendons to

be the most powerful predictor of early RA (sensitivity = 60%,

specificity = 73%). Including ACR criteria in the analysis, positive

serum RF and tenosynovitis were the strongest predictors of early RA

(sensitivity = 83%, specificity = 63%). When serum anti-cyclic

citrullinated peptides (CCP), ANA and CRP were included as additional

parameters, anti-CCP and flexor tenosynovitis were the strongest

predictors of early RA (sensitivity = 79%, specificity = 73%).

Conclusions. Flexor tenosynovitis diagnosed by MRI of the hand is a

strong predictor of early RA. Combining flexor tenosynovitis on MRI

with positive serum anti-CCP or positive RF is an even stronger

predictor of early RA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/8/887?etoc

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