What is the role of hand imaging in the workup of rheumatoid arthritis (RA)?

Updated: Mar 28, 2019
  • Author: Ian Y Y Tsou, MBBS, FRCR; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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The primary role of imaging in RA of the hands and wrists is to exclude septic arthritis. Percutaneous ultrasonography-guided aspiration may be useful for localizing and obtaining samples of any collection that can be found. (See the image below.)

Ultrasonography-guided synovial biopsy of the seco Ultrasonography-guided synovial biopsy of the second metacarpophalangeal joint of the right hand in a patient with rheumatoid arthritis of the hands. The biopsy needle is seen as a straight echogenic line on the left side of the image in an oblique orientation.

Radiography remains the first choice in imaging RA. Radiography is cheap, is easily reproducible, and allows easy serial comparison for assessment of disease progression. The main disadvantage is the absence of specific radiographic findings in early disease, since visualization of erosions may only be seen later. [1]  

Magnetic resonance imaging (MRI) provides a more accurate assessment, as well as earlier detection of lesions. Magnetic resonance imaging (MRI) continues to develop as a treatment tool, with the main thrust being detection of early disease at a stage at which disease-modifying drugs can be used; however, the cost of the examination and the small size of the joints involved limit widespread use. With further experience and cheaper scans, MRI scanning for the treatment of RA may gain acceptance in the future. [2, 1, 3, 4, 5]

Ultrasonography of specific joints based on radiographs may have a role as well. [2, 6]

RA may occur as part of a mixed connective tissue disease in which clinical and radiologic appearances are not typical of one particular disease.

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