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Comparison between the roles of musculoskeletal ultrasound and magnetic resonance imaging in detection of joint inflammation and destruction in rheumatoid arthritis

Abstract

Background

Detection of early signs of synovitis and bone erosions by modern radiological techniques such as musculoskeletal ultrasound (US) and MRI has gained a great interest, as early diagnosis and treatment to target for patients of rheumatoid arthritis (RA) has its impact on disease control.

Aim

The aim of the following study is to detect the ability of US compared with M Rl for the early detection of joint synovitis and bone erosion in RA patients.

Patients and methods

Six hundred joints (second to fifth metacarpophalangeal joints and second to fifth proximal interphalangeal joints) were examined in 50 patients with RA diagnosis.

Clinical assessment, noncontrast MRI, US, and conventional radiography were performed for synovitis and bone erosion evaluation.

Results and conclusion

We concluded that both US and MRI had high ability to detect inflamed joints with close agreement but favoring the US, especially with the added value of power Doppler US where it can reflect increased vascularity associated with inflammation and also with higher scores for these affected joints than that shown by MRI. On the other hand, the study has found that although both US and MRI had high ability to detect erosions with close agreement, the MRI favorably had higher scores for joint erosions compared with the scores shown by US.

References

  1. Scher JU. B-cell therapies for rheumatoid arthritis. Bull NYU Hosp Jt Dis 2012; 70:200–203

    PubMed  Google Scholar 

  2. Fiocco U, Sfriso P, Oliviero F, Pagnin E, Scagliori E, Campana C, et al. Co-stimulatory modulation in rheumatoid arthritis: the role of (CTLA4-lg) abatacept. Autoimmun Rev 2008;8:76–82

    Article  CAS  Google Scholar 

  3. Mclnnes IB, Schett G. Mechanisms of disease. The pathogenesis of rheumatoid arthritis. N Engl J Med 2011; 365:2205–2220

    Google Scholar 

  4. Ometto F, Botsios C, Raffeiner B, Sfriso P, Bernardi L, Todesco S, et al. Methods used to assess remission and low disease activity in rheumatoid arthritis. Autoimmun Rev 2010; 9:161–164

    Article  Google Scholar 

  5. Smolen JS, Aletaha D. Activity assessment in rheumatoid arthritis. Curr Opin Rheumatol 2008; 20:306–313

    Article  Google Scholar 

  6. Paulus HE. Defining remission in rheumatoid arthritis: what is it? Does it matter? J Rheumatol 2004; 31:1–4

    PubMed  Google Scholar 

  7. Tan YK, 0stergaard M, Conaghan PG. Imaging tools in rheumatoid arthritis: ultrasound vs magnetic resonance imaging. Rheumatology (Oxford) 2012; 51(Suppl 7):vii36–vii42

  8. Masic I, Ridjanovic Z, Pandza H, Masic I. Medical informatics. Sarajevo: Avicena; 2010. 416–430

    Google Scholar 

  9. Karim Z, Wakefield RJ, Quinn M, Conaghan PG, Brown AK, Veale DJ, et al. Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis Rheum 2004; 50:387–394

    Article  CAS  Google Scholar 

  10. Naredo E, Collado P, Cruz A, Palop MJ, Cabero F, Richi P, et al. Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. Arthritis Rheum 2007; 57:116–124

    Article  Google Scholar 

  11. Hameed B, Pilcher J, Heron C, Kiely PD. The relation between composite ultrasound measures and the DAS28 score, its components and acute phase markers in adult RA. Rheumatology (Oxford) 2008; 47:476–480

    Article  CAS  Google Scholar 

  12. Hodgson RJ, O’Connor P, Moots R. MRI of rheumatoid arthritis image quantitation for the assessment of disease activity, progression and response to therapy. Rheumatology (Oxford) 2008; 47:13–21

    Article  CAS  Google Scholar 

  13. Benton N, Stewart N.Crabbe J, Robinson E, Yeoman S, McQueen FM.MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann Rheum Dis 2004; 63:555–561

    Article  CAS  Google Scholar 

  14. Prevoo ML, van ’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38:44–48

    CAS  Google Scholar 

  15. Genant HK, Jiang Y, Peterfy C, Lu Y, Redei J, Countryman PJ. Assessment of rheumatoid arthritis using a modified scoring method on digitized and original radiographs. Arthritis Rheum 1998; 41:1583–1590

    Article  CAS  Google Scholar 

  16. Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48:955–962

    Article  Google Scholar 

  17. Conaghan PG, Emery P, Østergaard M, Keystone EC.Genovese MC, Hsia EC, et al. Assessment by MRI of inflammation and damage in rheumatoid arthritis patients with methotrexate inadequate response receiving golimumab: results of the GO-FORWARD trial. Ann Rheum Dis 2011; 70:1968–1974

    Article  CAS  Google Scholar 

  18. Østergaard M, Peterfy C, Conaghan P, McQueen F, Bird P, Ejbjerg B, et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 2003; 30:1385–1386

    PubMed  Google Scholar 

  19. Fuchs HA, Brooks RH, Callahan LF, Pincus T. A simplified twenty-eight-joint quantitative articular index in rheumatoid arthritis. Arthritis Rheum 1989; 32:531–537

    Article  CAS  Google Scholar 

  20. Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, et al. An explanation forthe apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008; 58:2958–2967

    Article  CAS  Google Scholar 

  21. Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, HensorE, et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 2006;54:3761–3773

    Article  CAS  Google Scholar 

  22. Colebatch AN, Edwards CJ, Ostergaard M, van der Heijde D, Balint PV, D’Agostin MA, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 2013; 72:804–14

    Article  Google Scholar 

  23. Mitran C, Barbulescu A, Vreju FA, Criveanu C, Rosu A, Ciurea P. Musculoskeletal ultrasound in early rheumatoid arthritis – correlations with disease activity score. Curr Health Sci J 2015;41:213–218

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Szkudlarek M, Klarlund M, Narvestad E, Court-Payen M, Strandberg C, Jensen KE, et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther 2006;8:R52

    Article  Google Scholar 

  25. Rahmani M, Chegini H, Najafizadeh SR, Azimi M, Habibollahi P, Shakiba M. Detection of bone erosion in early rheumatoid arthritis: ultrasonography and conventional radiography versus non-contrast magnetic resonance imaging. Clin Rheumatol 2010; 29:883–891

    Article  Google Scholar 

  26. Xiao H, Liu M.Tan L, Liao X, Li Y, Gao J. et al. Value of ultrasonography for diagnosis of synovitis associated with rheumatoid arthritis. Int J Rheum Dis 2014; 17:767–775

    Article  Google Scholar 

  27. Baillet A, Gaujoux-Viala C, Mouterde G, Pham T, Tebib J, Saraux A, et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatology (Oxford) 2011; 50:1137–1147

    Article  Google Scholar 

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Correspondence to Sherihan M Salama B.Ch., Msc.

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Salama, S.M. Comparison between the roles of musculoskeletal ultrasound and magnetic resonance imaging in detection of joint inflammation and destruction in rheumatoid arthritis. Egypt Rheumatol Rehabil 46, 62–69 (2019). https://doi.org/10.4103/1110-161X.247617

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Keywords

  • bone erosion
  • magnetic resonance imaging
  • rheumatoid arthritis
  • synovitis
  • ultrasonography