Magnetic resonance imaging in the assessment of metacarpophalangeal joint disease in early psoriatic and rheumatoid arthritis

Scand J Rheumatol. Mar-Apr 2009;38(2):79-83. doi: 10.1080/03009740802448833.

Abstract

Objectives: The aim of this study was to determine whether magnetic resonance imaging (MRI)-related entheseal changes including osteitis and extracapsular oedema could be used to differentiate between metacarpophalangeal (MCP) joint involvement in rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Methods: Twenty patients (10 each with early RA and PsA) had dynamic contrast-enhanced MRI (DCE-MRI) of swollen MCP joints. Synovitis and tenosynovitis was calculated using quantitative analysis including the degree and kinetics of enhancement of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Periarticular bone erosion and bone oedema were scored using the Outcome Measures in Rheumatology Clinical Trials (OMERACT) proposals. Entheseal-related features including extracapsular soft tissue enhancement or regions of diffuse bone oedema were also evaluated.

Results: MRI was not able to differentiate at the group level between both cohorts on the basis of entheseal-related disease but a subgroup of PsA patients had diffuse extracapsular enhancement (30%) or diffuse bone oedema (20%). The RA patient group had a greater degree of MCP synovitis (p<0.0001) and tenosynovitis than PsA patients (p<0.0001). There were no significant differences in either the total number of erosions (p = 0.315) or the presence of periarticular bone oedema (p = 0.105) between the groups.

Conclusion: Although conventional MRI shows evidence of an enthesitis-associated pathology in the MCP joints in PsA, this is not sufficiently common to be of diagnostic utility.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Arthritis, Psoriatic / complications
  • Arthritis, Psoriatic / diagnosis*
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / diagnosis*
  • Diagnosis, Differential
  • Edema / diagnosis
  • Edema / etiology
  • Female
  • Gadolinium DTPA
  • Humans
  • Joint Capsule / pathology
  • Magnetic Resonance Imaging / methods*
  • Male
  • Metacarpophalangeal Joint / pathology*
  • Metacarpophalangeal Joint / physiopathology
  • Middle Aged
  • Osteitis / diagnosis
  • Osteitis / physiopathology
  • Synovitis / diagnosis
  • Synovitis / etiology
  • Tenosynovitis / diagnosis
  • Tenosynovitis / etiology
  • Young Adult

Substances

  • Gadolinium DTPA