RESEARCH - MR Imaging Findings in Hands in Early RA: Comparison with Those in SLE and Primary SS

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Published online before print June 21, 2005, 10.1148/radiol.2361040844

(Radiology 2005;236:593.)

A more recent version of this article appeared on August 1, 2005

© RSNA, 2005

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Musculoskeletal Imaging

MR Imaging Findings in Hands in Early Rheumatoid Arthritis: Comparison with

Those in Systemic Lupus Erythematosus and Primary Sjögren Syndrome1

Nathalie Boutry, MD, Éric Hachulla, MD, René-Marc Flipo, MD, Bernard Cortet,

MD and Anne Cotten, MD

1 From the Departments of Musculoskeletal Radiology (N.B., A.C.), Internal

Medicine (E.H.), and Rheumatology (R.M.F., B.C.) and the Unité de Recherche

de l'Appareil Locomoteur (N.B., R.M.F., B.C., A.C.), Hôpital Salengro,

Centre Hospitalier Régional Universitaire de Lille, Blvd du Professeur

Leclercq, 59037 Lille CEDEX, France. Received May 10, 2004; revision

requested July 27; revision received August 13; accepted September 11.

Address correspondence to N.B. (e-mail: nboutry@... ).

PURPOSE: To evaluate prospectively the use of magnetic resonance (MR)

imaging for differentiating true rheumatoid arthritis (RA) from systemic

lupus erythematosus (SLE) or primary Sjögren syndrome in patients who have

inflammatory polyarthralgia of the hands but no radiographic evidence of RA.

MATERIALS AND METHODS: This study had institutional review board approval,

and patient informed consent was obtained. Twenty-eight patients (16 female

and 12 male patients; mean age, 42 years) with early RA and 19 patients (18

female and one male patient; mean age, 46 years) with SLE (n = 14) or

primary Sjögren syndrome (n = 5) underwent MR imaging of both hands. All

patients had inflammatory polyarthralgia of the hands and no evidence of

erosive changes on radiographs. Coronal T2-weighted short inversion time

inversion-recovery, transverse T1-weighted spin-echo, transverse

fat-suppressed gadolinium-enhanced T1-weighted spin-echo, and transverse

gadolinium-enhanced three-dimensional gradient-echo MR images were obtained.

The following MR imaging variables were assessed in the wrist and nonthumb

metacarpophalangeal joints: synovitis, bone lesions (erosion, defect, and

edema), and tenosynovitis. Synovitis and bone lesions were scored with the

OMERACT RA-MRI scoring system. Findings in patients with RA and those

without RA were compared by means of Mann-Whitney, 2, and Fisher exact

tests.

RESULTS: The only significant difference between the two groups in terms of

individual scores for synovitis, bone lesions, and tenosynovitis was the

more frequent presence of tenosynovitis of the right fourth extensor tendon

in patients without RA (P = .04). There were no significant differences

between patients with RA and those without RA in terms of global scores for

synovitis, bone lesions, and tenosynovitis. However, bone marrow edema in

the metacarpophalangeal joints was seen more frequently in patients with RA

(P < .001).

CONCLUSION: It may be impossible to distinguish between patients with early

RA and those without RA (ie, those with SLE or primary Sjögren syndrome) by

means of MR imaging.

© RSNA, 2005

http://radiology.rsnajnls.org/cgi/content/abstract/2361040844v1

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