What is the most effective method of hand imaging in rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Hand imaging in RA can include radiography, MRI, ultrasonography, and computed tomography (CT), though the last of these plays only a minimal role. Radiography is the mainstay of imaging RA in the hands: It is inexpensive and easily reproducible, and it allows easy serial comparison for assessment of disease progression. Its main disadvantage is the absence of specific radiographic findings in early disease; erosions may only be visualized later.

MRI is sensitive than radiography to early changes in RA, and in the appropriate clinical setting, it is more accurate than plain radiography in the diagnosis of the disease. However, a systematic literature review concluded that widespread use of MRI for the diagnosis of early RA and for helping determine the prognosis of early RA is not currently recommended, though MRI bone edema may be predictive of progression in certain RA populations. [58]

Ultrasonography has been applied to the assessment of RA with the goal of improving on the current standard of conventional radiography. Like MRI, ultrasonography serves as an early diagnostic tool and can help in evaluating the cause of joint swelling in a patient with RA. [59, 60] However, the results of one study suggested that NSAID use may mask the ultrasonographic gray scale and power Doppler signal in the assessment of synovitis in RA, resulting in lower scoring despite continuing disease activity. [61]

See Rheumatoid Arthritis Hand Imaging for complete information on this topic.


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