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Bilateral evaluation of the hand and wrist in untreated early inflammatory arthritis: a comparative study of ultrasonography and magnetic resonance imaging.
J Rheumatol. 2013 Aug; 40(8):1282-92.JR

Abstract

OBJECTIVE

To compare Doppler ultrasound (US) and 3.0-Tesla magnetic resonance imaging (3.0-T MRI) findings of synovial inflammation in the tendons and joints in an early polyarthritis cohort (patients who presented < 1 year after arthritis onset) using a bilateral hand and wrist evaluation. Also, to evaluate the diagnostic performance of US and MRI findings for rheumatoid arthritis (RA), their ability to predict RA as a diagnostic outcome, and their capacity to improve the accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA classification criteria in early arthritis.

METHODS

Forty-five patients (40 women, 5 men; mean age 45.6 yrs) with untreated recent-onset polyarthritis participated in this prospective study and were examined using an US and MRI approach including both wrists and hands. After a followup of 12 months, patients were classified as having RA if they fulfilled the criteria for RA. The proportion of synovitis identified by US and MRI for each joint and tendon region was compared by chi-square test. The diagnostic performance of US and MRI for RA identification was evaluated using receiver-operating curve (ROC) analysis. Possible associations between synovitis for each joint and tendon region as identified by US or MRI and RA diagnosis at 12 months were tested by logistic regression analysis. The diagnostic performance of the ACR/EULAR RA classification criteria corrected by US and MRI joint and tendon counts was evaluated using ROC analysis.

RESULTS

Thirty patients fulfilled the ACR/EULAR criteria [early RA (ERA) patients] and the remaining 15 failed to meet these criteria (non-RA). Carpal joint synovitis and tenosynovitis of the flexor tendons was found in 86.7% and 86.7% of patients with ERA on MRI compared with 63.3% and 50% on US, respectively (p < 0.05). The global MRI and US counts revealed a good diagnostic performance for RA diagnosis of both techniques, although MRI was statistically significantly better [area under the curve (AUC) = 0.959 and AUC = 0.853, respectively; z statistic = 2.210, p < 0.05]. MRI identification of carpal joint synovitis (OR 3.64, 95% CI 1.119-11.841), tenosynovitis of the flexor tendons (OR 5.09, 95% CI 1.620-16.051), and global joint and tendon count (OR 2.77, 95% CI 1.249-6.139) were in the multivariate logistic regression model the most powerful predictors of progression toward RA. In the group of ERA patients with US joint and tendon counts ≤ 10, a statistically significant difference was found between the diagnostic performance for RA of the ACR/EULAR criteria as previously described and the diagnostic performance of the MRI-corrected ACR/EULAR criteria (AUC = 0.898 and AUC = 0.986, respectively; z statistic = 2.181, p < 0.05).

CONCLUSION

3.0-T MRI identified a higher prevalence of synovitis in comparison to US in an early polyarthritis cohort. Both techniques have good diagnostic performance for RA although MRI reveals a significantly higher diagnostic capability. Synovitis of carpal joints and of flexor tendons as identified by MRI were the most powerful predictors of progression toward RA. In patients with US joint and tendon counts ≤ 10, MRI can significantly improve the diagnostic performance of the 2010 ACR/EULAR classification criteria.

Authors+Show Affiliations

Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal. rcio.navalho@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

23729806

Citation

Navalho, Márcio, et al. "Bilateral Evaluation of the Hand and Wrist in Untreated Early Inflammatory Arthritis: a Comparative Study of Ultrasonography and Magnetic Resonance Imaging." The Journal of Rheumatology, vol. 40, no. 8, 2013, pp. 1282-92.
Navalho M, Resende C, Rodrigues AM, et al. Bilateral evaluation of the hand and wrist in untreated early inflammatory arthritis: a comparative study of ultrasonography and magnetic resonance imaging. J Rheumatol. 2013;40(8):1282-92.
Navalho, M., Resende, C., Rodrigues, A. M., Pereira da Silva, J. A., Fonseca, J. E., Campos, J., & Canhão, H. (2013). Bilateral evaluation of the hand and wrist in untreated early inflammatory arthritis: a comparative study of ultrasonography and magnetic resonance imaging. The Journal of Rheumatology, 40(8), 1282-92. https://doi.org/10.3899/jrheum.120713
Navalho M, et al. Bilateral Evaluation of the Hand and Wrist in Untreated Early Inflammatory Arthritis: a Comparative Study of Ultrasonography and Magnetic Resonance Imaging. J Rheumatol. 2013;40(8):1282-92. PubMed PMID: 23729806.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bilateral evaluation of the hand and wrist in untreated early inflammatory arthritis: a comparative study of ultrasonography and magnetic resonance imaging. AU - Navalho,Márcio, AU - Resende,Catarina, AU - Rodrigues,Ana Maria, AU - Pereira da Silva,J Alberto, AU - Fonseca,João Eurico, AU - Campos,Jorge, AU - Canhão,Helena, Y1 - 2013/06/01/ PY - 2013/6/5/entrez PY - 2013/6/5/pubmed PY - 2014/7/1/medline KW - ACR/EULAR KW - EARLY ARTHRITIS KW - MAGNETIC RESONANCE IMAGING KW - RHEUMATOID ARTHRITIS KW - ULTRASOUND SP - 1282 EP - 92 JF - The Journal of rheumatology JO - J Rheumatol VL - 40 IS - 8 N2 - OBJECTIVE: To compare Doppler ultrasound (US) and 3.0-Tesla magnetic resonance imaging (3.0-T MRI) findings of synovial inflammation in the tendons and joints in an early polyarthritis cohort (patients who presented < 1 year after arthritis onset) using a bilateral hand and wrist evaluation. Also, to evaluate the diagnostic performance of US and MRI findings for rheumatoid arthritis (RA), their ability to predict RA as a diagnostic outcome, and their capacity to improve the accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA classification criteria in early arthritis. METHODS: Forty-five patients (40 women, 5 men; mean age 45.6 yrs) with untreated recent-onset polyarthritis participated in this prospective study and were examined using an US and MRI approach including both wrists and hands. After a followup of 12 months, patients were classified as having RA if they fulfilled the criteria for RA. The proportion of synovitis identified by US and MRI for each joint and tendon region was compared by chi-square test. The diagnostic performance of US and MRI for RA identification was evaluated using receiver-operating curve (ROC) analysis. Possible associations between synovitis for each joint and tendon region as identified by US or MRI and RA diagnosis at 12 months were tested by logistic regression analysis. The diagnostic performance of the ACR/EULAR RA classification criteria corrected by US and MRI joint and tendon counts was evaluated using ROC analysis. RESULTS: Thirty patients fulfilled the ACR/EULAR criteria [early RA (ERA) patients] and the remaining 15 failed to meet these criteria (non-RA). Carpal joint synovitis and tenosynovitis of the flexor tendons was found in 86.7% and 86.7% of patients with ERA on MRI compared with 63.3% and 50% on US, respectively (p < 0.05). The global MRI and US counts revealed a good diagnostic performance for RA diagnosis of both techniques, although MRI was statistically significantly better [area under the curve (AUC) = 0.959 and AUC = 0.853, respectively; z statistic = 2.210, p < 0.05]. MRI identification of carpal joint synovitis (OR 3.64, 95% CI 1.119-11.841), tenosynovitis of the flexor tendons (OR 5.09, 95% CI 1.620-16.051), and global joint and tendon count (OR 2.77, 95% CI 1.249-6.139) were in the multivariate logistic regression model the most powerful predictors of progression toward RA. In the group of ERA patients with US joint and tendon counts ≤ 10, a statistically significant difference was found between the diagnostic performance for RA of the ACR/EULAR criteria as previously described and the diagnostic performance of the MRI-corrected ACR/EULAR criteria (AUC = 0.898 and AUC = 0.986, respectively; z statistic = 2.181, p < 0.05). CONCLUSION: 3.0-T MRI identified a higher prevalence of synovitis in comparison to US in an early polyarthritis cohort. Both techniques have good diagnostic performance for RA although MRI reveals a significantly higher diagnostic capability. Synovitis of carpal joints and of flexor tendons as identified by MRI were the most powerful predictors of progression toward RA. In patients with US joint and tendon counts ≤ 10, MRI can significantly improve the diagnostic performance of the 2010 ACR/EULAR classification criteria. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/23729806/Bilateral_evaluation_of_the_hand_and_wrist_in_untreated_early_inflammatory_arthritis:_a_comparative_study_of_ultrasonography_and_magnetic_resonance_imaging_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&amp;pmid=23729806 DB - PRIME DP - Unbound Medicine ER -