RESEARCH - On 2 MRI approaches and radiographic evaluation in RA

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Arthritis Rheum. 2005 Aug;52(8):2300-6.

The smallest detectable difference and sensitivity to change of magnetic

resonance imaging and radiographic scoring of structural joint damage in

rheumatoid arthritis finger, wrist, and toe joints: A comparison of the

omeract rheumatoid arthritis magnetic resonance imaging score applied to

different joint combinations and the sharp/van der heijde radiographic

score.

Ejbjerg BJ, Vestergaard A, sen S, Thomsen HS, Ostergaard M.

Copenhagen University Hospitals at Hvidovre, Rigshospitalet, and Herlev,

Copenhagen, Denmark.

OBJECTIVE: To compare 2 magnetic resonance imaging (MRI) approaches and

radiographic evaluation according to the Sharp/van der Heijde method with

respect to sensitivity to change in joint destruction in patients with

rheumatoid arthritis (RA). METHODS: Thirty-five RA patients and 9 healthy

controls underwent MRI and radiography on 2 occasions 1 year apart.

Conventional radiographs of the hands, wrists, and forefeet were evaluated

according to the Sharp/van der Heijde method. MRIs of unilateral wrist and

second through fifth metacarpophalangeal (MCP) joints ( " few-joints

approach " ) and of bilateral wrist and MCP joints plus unilateral

metatarsophalangeal (MTP) joints ( " many-joints approach " ) were assessed for

bone erosions according to the scoring system recommended by the OMERACT

(Outcome Measures in Rheumatology Clinical Trials) group. The smallest

detectable differences (SDDs) of the radiography and MRI scores were

computed based on reevaluation of one-third of the study population.

RESULTS: Progressive joint destruction, i.e., an increase in score after the

followup period, was observed more frequently with the MRI " many-joints

approach " (30 subjects) and " few-joints approach " (25 subjects) than with

the Sharp/van der Heijde radiographic method (9 subjects) (P < 0.001 by

chi-square analysis). No significant difference between the MRI approaches

was observed. When only subjects with a change greater than the SDD were

considered, progression was revealed with the MRI " many-joints approach, "

the MRI " few-joints approach, " and radiography in 15, 13, and 5 RA subjects,

respectively. With both MRI approaches, significantly more subjects with

progression were detected than were detected by radiography (P < 0.05).

CONCLUSION: MRI, regardless of whether it covers unilateral wrist and MCP

joints or bilateral wrist and MCP joints plus unilateral MTP joints, is

significantly superior to radiography of the hands, wrists, and forefeet

with respect to detection of progressive joint destruction in RA.

PMID: 16052593

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6052593 & dopt=Abstract

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