Comparative study of the detection of joint injury in early‐stage rheumatoid arthritis by magnetic resonance imaging of the wrist and finger joints and physical examination

TLDR

The study aimed to assess whether MRI‑detected joint injury is more sensitive than physical examination in early‑stage rheumatoid arthritis. MRI of both wrists and fingers was performed on 51 early‑stage RA patients, defining injury as synovitis, bone edema, or erosion, while a certified rheumatologist assessed tenderness or swelling in the same joints. MRI identified joint injury in 521 of 1,110 sites, significantly more than the 305 sites detected by physical exam (P = 1.1 × 10⁻¹²), and the severity of MRI findings correlated with physical exam severity (r = 0.469).

Abstract

To verify whether magnetic resonance imaging (MRI)-proven joint injury is sensitive as compared with joint injury determined by physical examination.MRI of the wrist and finger joints of both hands was examined in 51 early-stage rheumatoid arthritis (RA) patients by both plain and gadolinium diethylenetriaminepentaacetic acid-enhanced MRI. Synovitis, bone edema, and bone erosion (the latter two included as bone lesions at the wrist joints); metacarpophalangeal joints; and proximal interphalangeal joints were considered as MRI-proven joint injury. Japan College of Rheumatology-certified rheumatologists had given a physical examination just before the MRI study. The presence of tender and/or swollen joints in the same fields as MRI was considered as joint injury on physical examination. The association of MRI-proven joint injury with physical examination-proven joint injury was examined.A total of 1,110 sites were available to be examined. MRI-proven joint injury was found in 521 sites, whereas the other 589 sites were normal. Physical examination-proven joint injury was found in 305 sites, which was significantly low as compared with MRI-proven joint injury (P = 1.1 × 10(-12) versus MRI). Joint injury on physical examination was not found in 81.5% of the sites where MRI findings were normal. Furthermore, an association of the severity of MRI-proven joint injury with that of joint injury on physical examination was clearly demonstrated (P = 1.6 × 10(-15), r(s) = 0.469).Our present data suggest that MRI is not only sensitive but accurately reflects the joint injury in patients with early-stage RA.