Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2000 Jul;59(7):521–528. doi: 10.1136/ard.59.7.521

Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis

M Klarlund 1, M Ostergaard 1, K Jensen 1, J Madsen 1, H Skjodt 1, I Lorenzen 1, T the 1
PMCID: PMC1753194  PMID: 10873961

Abstract

OBJECTIVES—To evaluate synovial membrane hypertrophy, tenosynovitis, and erosion development of the 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints by magnetic resonance imaging in a group of patients with rheumatoid arthritis (RA) or suspected RA followed up for one year. Additionally, to compare the results with radiography, bone scintigraphy, and clinical findings.
PATIENTS AND METHODS—Fifty five patients were examined at baseline, of whom 34 were followed up for one year. Twenty one patients already fulfilled the American College of Rheumatology (ACR) criteria for RA at baseline, five fulfilled the criteria only after one year's follow up, whereas eight maintained the original diagnosis of early unclassified polyarthritis. The following MRI variables were assessed at baseline and one year: synovial membrane hypertrophy score, number of erosions, and tenosynovitis score.
RESULTS—MRI detected progression of erosions earlier and more often than did radiography of the same joints; at baseline the MRI to radiography ratio was 28:4. Erosions were exclusively found in patients with RA at baseline or fulfilling the ACR criteria at one year. At one year follow up, scores of MR synovial membrane hypertrophy, tenosynovitis, and scintigraphic tracer accumulation had not changed significantly from baseline; in contrast, swollen and tender joint counts had declined significantly (p<0.05).
CONCLUSIONS—MRI detected more erosions than radiography. MR synovial membrane hypertrophy and scintigraphy scores did not parallel the changes seen over time in clinically assessed swollen and tender joint counts. Although joint disease activity may be assessed as quiescent by conventional clinical methods, a more detailed evaluation by MRI may show that a pathological condition is still present within the synovium.



Full Text

The Full Text of this article is available as a PDF (202.0 KB).

Figure 1  .

Figure 1  

Open in a new tab

(A) Distribution of magnetic resonance imaging synovial membrane hypertrophy scores (0-4) in each finger joint (given as a percentage for each score (0-4)). (B) Clinical assessment in individual 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints at baseline (55 patients); black indicates the percentage of joints without swelling and tenderness while white indicates the percentage of joints with swelling or tenderness, or both.

Figure 2  .

Figure 2  

Open in a new tab

Distribution of magnetic resonance (MR) erosions at baseline and at the one year follow up of the 2nd to 5th metacarpophalangeal and proximal interphalangeal joints of the dominant hand (of 32 right handed and two left handed patients). A dot represents an MR erosion at baseline. A triangle represents a new MR erosion at the one year follow up.

Figure 3  .

Figure 3  

Open in a new tab

Magnetic resonance images of the three new erosions (white arrows) developed within the observation period of one year in three patients. T1 weighted, spin echo, pre-contrast axial images (A) at baseline, and (B) at the one year follow up; a new erosion is seen in the 3rd metacarpophalangeal (MCP) joint. (C) T1 weighted, spin echo, pre-contrast coronal image at baseline and (D) at the one year follow up, a new erosion is seen in the 4th MCP joint. (E) T1 weighted, spin echo, pre-contrast coronal image at baseline and (F) at the one year follow up, a new erosion is seen in the 3rd MCP joint.

Figure 4  .

Figure 4  

Open in a new tab

Distribution of radiographic erosions at baseline and at the one year follow up in both hands (34 patients). A dot represents an erosion at baseline. A triangle represents a new erosion at the one year follow up. Erosions found in dominant hands (32 right handed and two left handed) are indicated on the hand to the right in the figure, whereas erosions found in non dominant hands are indicated on the hand to the left.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adam G., Dammer M., Bohndorf K., Christoph R., Fenke F., Günther R. W. Rheumatoid arthritis of the knee: value of gadopentetate dimeglumine-enhanced MR imaging. AJR Am J Roentgenol. 1991 Jan;156(1):125–129. doi: 10.2214/ajr.156.1.1898545. [DOI] [PubMed] [Google Scholar]
  2. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  3. Backhaus M., Kamradt T., Sandrock D., Loreck D., Fritz J., Wolf K. J., Raber H., Hamm B., Burmester G. R., Bollow M. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum. 1999 Jun;42(6):1232–1245. doi: 10.1002/1529-0131(199906)42:6<1232::AID-ANR21>3.0.CO;2-3. [DOI] [PubMed] [Google Scholar]
  4. Björkengren A. G., Geborek P., Rydholm U., Holtås S., Petterson H. MR imaging of the knee in acute rheumatoid arthritis: synovial uptake of gadolinium-DOTA. AJR Am J Roentgenol. 1990 Aug;155(2):329–332. doi: 10.2214/ajr.155.2.2115261. [DOI] [PubMed] [Google Scholar]
  5. Brook A., Corbett M. Radiographic changes in early rheumatoid disease. Ann Rheum Dis. 1977 Feb;36(1):71–73. doi: 10.1136/ard.36.1.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Emery P. Therapeutic approaches for early rheumatoid arthritis. How early? How aggressive? Br J Rheumatol. 1995 Nov;34 (Suppl 2):87–90. [PubMed] [Google Scholar]
  7. Felson D. T., Anderson J. J., Boers M., Bombardier C., Chernoff M., Fried B., Furst D., Goldsmith C., Kieszak S., Lightfoot R. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993 Jun;36(6):729–740. doi: 10.1002/art.1780360601. [DOI] [PubMed] [Google Scholar]
  8. Firestein G. S. Starving the synovium: angiogenesis and inflammation in rheumatoid arthritis. J Clin Invest. 1999 Jan;103(1):3–4. doi: 10.1172/JCI5929. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fleming A., Benn R. T., Corbett M., Wood P. H. Early rheumatoid disease. II. Patterns of joint involvement. Ann Rheum Dis. 1976 Aug;35(4):361–364. doi: 10.1136/ard.35.4.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Foley-Nolan D., Stack J. P., Ryan M., Redmond U., Barry C., Ennis J., Coughlan R. J. Magnetic resonance imaging in the assessment of rheumatoid arthritis--a comparison with plain film radiographs. Br J Rheumatol. 1991 Apr;30(2):101–106. doi: 10.1093/rheumatology/30.2.101. [DOI] [PubMed] [Google Scholar]
  11. Fuchs H. A., Pincus T. Radiographic damage in rheumatoid arthritis: description by nonlinear models. J Rheumatol. 1992 Nov;19(11):1655–1658. [PubMed] [Google Scholar]
  12. Halla J. T., Fallahi S., Hardin J. G. Small joint involvement: a systematic roentgenographic study in rheumatoid arthritis. Ann Rheum Dis. 1986 Apr;45(4):327–330. doi: 10.1136/ard.45.4.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hervé-Somma C. M., Sebag G. H., Prieur A. M., Bonnerot V., Lallemand D. P. Juvenile rheumatoid arthritis of the knee: MR evaluation with Gd-DOTA. Radiology. 1992 Jan;182(1):93–98. doi: 10.1148/radiology.182.1.1727317. [DOI] [PubMed] [Google Scholar]
  14. Jevtic V., Rozman B., Watt I., Presetnik M. Use of contrast enhanced MRI in the assessment of therapeutic response to a disease-modifying antirheumatic drug. Case study of a patient with rheumatoid arthritis--6- and 24-month follow up. Br J Rheumatol. 1995 Oct;34(10):956–959. doi: 10.1093/rheumatology/34.10.956. [DOI] [PubMed] [Google Scholar]
  15. Jevtic V., Watt I., Rozman B., Kos-Golja M., Demsar F., Jarh O. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol. 1995 Jul;24(5):351–355. doi: 10.1007/BF00197064. [DOI] [PubMed] [Google Scholar]
  16. Jevtic V., Watt I., Rozman B., Kos-Golja M., Praprotnik S., Logar D., Presetnik M., Demsar F., Jarh O., Campion G. Contrast enhanced Gd-DTPA magnetic resonance imaging in the evaluation of rheumatoid arthritis during a clinical trial with DMARDs. A prospective two-year follow-up study on hand joints in 31 patients. Clin Exp Rheumatol. 1997 Mar-Apr;15(2):151–156. [PubMed] [Google Scholar]
  17. Jevtic V., Watt I., Rozman B., Presetnik M., Logar D., Praprotnik S., Tomsic M., Sipek A., Kos-Golja M., Sepe A. Prognostic value of contrast enhanced Gd-DTPA MRI for development of bone erosive changes in rheumatoid arthritis. Br J Rheumatol. 1996 Dec;35 (Suppl 3):26–30. doi: 10.1093/rheumatology/35.suppl_3.26. [DOI] [PubMed] [Google Scholar]
  18. Kirwan J. R. The relationship between synovitis and erosions in rheumatoid arthritis. Br J Rheumatol. 1997 Feb;36(2):225–228. doi: 10.1093/rheumatology/36.2.225. [DOI] [PubMed] [Google Scholar]
  19. Klarlund M., Ostergaard M., Gideon P., Sørensen K., Jensen K. E., Lorenzen I. Wrist and finger joint MR imaging in rheumatoid arthritis. Acta Radiol. 1999 Jul;40(4):400–409. doi: 10.3109/02841859909177754. [DOI] [PubMed] [Google Scholar]
  20. Klarlund M., Ostergaard M., Lorenzen I. Finger joint synovitis in rheumatoid arthritis: quantitative assessment by magnetic resonance imaging. Rheumatology (Oxford) 1999 Jan;38(1):66–72. doi: 10.1093/rheumatology/38.1.66. [DOI] [PubMed] [Google Scholar]
  21. Klarlund M., Ostergaard M., Rostrup E., Skjødt H., Lorenzen I. Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthritis, early unclassified polyarthritis, and healthy controls. Scand J Rheumatol. 2000;29(2):108–115. doi: 10.1080/030097400750001914. [DOI] [PubMed] [Google Scholar]
  22. Kuper I. H., van Leeuwen M. A., van Riel P. L., Sluiter W. J., Houtman N. M., Cats H. A., van Rijswijk M. H. Influence of a ceiling effect on the assessment of radiographic progression in rheumatoid arthritis during the first 6 years of disease. J Rheumatol. 1999 Feb;26(2):268–276. [PubMed] [Google Scholar]
  23. Larsen A., Dale K., Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977 Jul;18(4):481–491. doi: 10.1177/028418517701800415. [DOI] [PubMed] [Google Scholar]
  24. Larsen A. How to apply Larsen score in evaluating radiographs of rheumatoid arthritis in long-term studies. J Rheumatol. 1995 Oct;22(10):1974–1975. [PubMed] [Google Scholar]
  25. Larsen A., Thoen J. Hand radiography of 200 patients with rheumatoid arthritis repeated after an interval of one year. Scand J Rheumatol. 1987;16(6):395–401. doi: 10.3109/03009748709165409. [DOI] [PubMed] [Google Scholar]
  26. McGonagle D., Conaghan P. G., O'Connor P., Gibbon W., Green M., Wakefield R., Ridgway J., Emery P. The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study. Arthritis Rheum. 1999 Aug;42(8):1706–1711. doi: 10.1002/1529-0131(199908)42:8<1706::AID-ANR20>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  27. McQueen F. M., Stewart N., Crabbe J., Robinson E., Yeoman S., Tan P. L., McLean L. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis. 1998 Jun;57(6):350–356. doi: 10.1136/ard.57.6.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. McQueen F. M., Stewart N., Crabbe J., Robinson E., Yeoman S., Tan P. L., McLean L. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis. 1999 Mar;58(3):156–163. doi: 10.1136/ard.58.3.156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Möttönen T. T., Hannonen P., Toivanen J., Rekonen A., Oka M. Value of joint scintigraphy in the prediction of erosiveness in early rheumatoid arthritis. Ann Rheum Dis. 1988 Mar;47(3):183–189. doi: 10.1136/ard.47.3.183. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. NORGAARD F. EARLIEST ROENTGENOLOGICAL CHANGES IN POLYARTHRITIS OF THE RHEUMATOID TYPE: RHEUMATOID ARTHRITIS. Radiology. 1965 Aug;85:325–329. doi: 10.1148/85.2.325. [DOI] [PubMed] [Google Scholar]
  31. Ostergaard M., Gideon P., Sørensen K., Hansen M., Stoltenberg M., Henriksen O., Lorenzen I. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist. Scand J Rheumatol. 1995;24(4):212–218. doi: 10.3109/03009749509100876. [DOI] [PubMed] [Google Scholar]
  32. Ostergaard M., Hansen M., Stoltenberg M., Gideon P., Klarlund M., Jensen K. E., Lorenzen I. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum. 1999 May;42(5):918–929. doi: 10.1002/1529-0131(199905)42:5<918::AID-ANR10>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
  33. Peterfy C. G., Roberts T., Genant H. K. Dedicated extremity MR imaging. An emerging technology. Radiol Clin North Am. 1997 Jan;35(1):1–20. [PubMed] [Google Scholar]
  34. Pincus T., Callahan L. F., Fuchs H. A., Larsen A., Kaye J. Quantitative analysis of hand radiographs in rheumatoid arthritis: time course of radiographic changes, relation to joint examination measures, and comparison of different scoring methods. J Rheumatol. 1995 Oct;22(10):1983–1989. [PubMed] [Google Scholar]
  35. Polisson R. P., Schoenberg O. I., Fischman A., Rubin R., Simon L. S., Rosenthal D., Palmer W. E. Use of magnetic resonance imaging and positron emission tomography in the assessment of synovial volume and glucose metabolism in patients with rheumatoid arthritis. Arthritis Rheum. 1995 Jun;38(6):819–825. doi: 10.1002/art.1780380616. [DOI] [PubMed] [Google Scholar]
  36. Salaffi F., Ferraccioli G. F. Progress of the anatomical damage in rheumatoid hands. Radiography of the natural course of the disease or of the course during treatment? Scand J Rheumatol. 1989;18(2):119–120. doi: 10.3109/03009748909099927. [DOI] [PubMed] [Google Scholar]
  37. Scott D. L., Coulton B. L., Popert A. J. Long term progression of joint damage in rheumatoid arthritis. Ann Rheum Dis. 1986 May;45(5):373–378. doi: 10.1136/ard.45.5.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Storgard C. M., Stupack D. G., Jonczyk A., Goodman S. L., Fox R. I., Cheresh D. A. Decreased angiogenesis and arthritic disease in rabbits treated with an alphavbeta3 antagonist. J Clin Invest. 1999 Jan;103(1):47–54. doi: 10.1172/JCI3756. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Sugimoto H., Takeda A., Kano S. Assessment of disease activity in rheumatoid arthritis using magnetic resonance imaging: quantification of pannus volume in the hands. Br J Rheumatol. 1998 Aug;37(8):854–861. doi: 10.1093/rheumatology/37.8.854. [DOI] [PubMed] [Google Scholar]
  40. Sugimoto H., Takeda A., Masuyama J., Furuse M. Early-stage rheumatoid arthritis: diagnostic accuracy of MR imaging. Radiology. 1996 Jan;198(1):185–192. doi: 10.1148/radiology.198.1.8539375. [DOI] [PubMed] [Google Scholar]
  41. Van de Wiele C., Van den Bosch F., Mielants H., Simons M., Veys E. M., Dierckx R. A. Bone scintigraphy of the hands in early stage lupus erythematosus and rheumatoid arthritis. J Rheumatol. 1997 Oct;24(10):1916–1921. [PubMed] [Google Scholar]
  42. Wolfe F., Kleinheksel S. M., Cathey M. A., Hawley D. J., Spitz P. W., Fries J. F. The clinical value of the Stanford Health Assessment Questionnaire Functional Disability Index in patients with rheumatoid arthritis. J Rheumatol. 1988 Oct;15(10):1480–1488. [PubMed] [Google Scholar]
  43. van der Heijde D. M. Plain X-rays in rheumatoid arthritis: overview of scoring methods, their reliability and applicability. Baillieres Clin Rheumatol. 1996 Aug;10(3):435–453. doi: 10.1016/s0950-3579(96)80043-4. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES