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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2004 May;63(5):555–561. doi: 10.1136/ard.2003.011544

MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years

N Benton 1, N Stewart 1, J Crabbe 1, E Robinson 1, S Yeoman 1, F McQueen 1
PMCID: PMC1755000  PMID: 15082487

Abstract

Objectives: To determine whether magnetic resonance (MR) scans of the dominant wrist of patients with early rheumatoid arthritis (RA) can be used to predict functional outcome at 6 years' follow up.

Methods: Dominant wrist MR scans were obtained in 42 patients with criteria for RA at first presentation. Patients were followed up prospectively for 6 years, and further scans obtained at 1 year (42 patients) and 6 years (31 patients). Two radiologists scored scans for synovitis, tendonitis, bone oedema, and erosions. The Stanford Health Assessment Questionnaire (HAQ) score, indicating functional outcome, and standard measures of disease activity were assessed at 0, 1, 2, and 6 years. The physical function component of the SF-36 score (PF-SF36) was also used as a functional outcome measure at 6 years.

Results: Baseline MR parameters, including bone oedema score and the total baseline MR score, were predictive of the PF-SF36 at 6 years (R2 = 0.22, p = 0.005 and R2 = 0.16, p = 0.02, respectively). The PF-SF36 score correlated strongly with the HAQ score at 6 years (rs = –0.725, p<0.0001); none of the baseline MR parameters predicted the 6 year HAQ score. The total MR score obtained at 1 year was predictive of the 6 year HAQ (R2 = 0.04, p = 0.01). Standard clinical and radiographic measures at baseline were not predictive of the 6 year PF-SF36, but when combined in a model with baseline MR oedema score, prediction increased from 0.09 to 0.23, or 23% of the 6 year variance.

Conclusion: MR imaging of the wrist in patients with early RA can help to predict function at 6 years and could be used to plan aggressive management at an earlier stage.

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Figure 1 .

Figure 1

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Progression of MR, clinical, and functional parameters over 6 years. Solid lines indicate median scores at 0, 1, and 6 years for MR parameters and 0, 1, 2, and 6 years for DAS and HAQ. Dotted lines indicate interquartile ranges.

Figure 2 .

Figure 2

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Sequential MR scans of the dominant carpus over 6 years in a 44 year old patient who was non-compliant with disease modifying treatment. This patient has congenital fusion of the triquetrum and lunate. (A) The baseline T1 weighted coronal scan shows focal areas of bone oedema as low signal within the capitate and the triquetrum/lunate (short arrows). There is extensive synovitis adjacent to the scaphoid (long arrow). (B) Axial T1 weighted image (baseline) showing bone oedema as low signal within the distal radius. (C) Equivalent baseline axial T2 weighted image showing bone oedema within the radius as bright signal. (D) Coronal T1 weighted scan at 1 year showing discrete low signal regions breaching the cortex of the capitate and the radial styloid indicating erosions (arrows). There is also extensive bone oedema within the hamate (circle). (E) Axial T1 weighted image at 1 year showing erosion at the radius. (F) Coronal T1 weighted scan at 6 years showing extensive erosive disease at multiple sites (arrows). (G) Axial T1 weighted image at 6 years showing more extensive erosion at the radius.

Selected References

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