What is the degree of confidence in the use of had radiographs in the diagnosis of rheumatoid arthritis (RA)?

Answer

RA is indicated on radiographs by the overall pattern and features of joint involvement. Although the presence of bony erosions is typical of RA, erosions are not specific because of the large number of other erosive arthritides. An absence of osteophyte formation and subchondral sclerosis is also indicative of RA rather than osteoarthritis.

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Guermazi A, Taouli B, Lynch JA, Peterfy CG. Imaging of bone erosion in rheumatoid arthritis. Semin Musculoskelet Radiol. 2004 Dec. 8(4):269-85. [Medline].
Tehranzadeh J, Ashikyan O, Dascalos J. Advanced imaging of early rheumatoid arthritis. Radiol Clin North Am. 2004 Jan. 42(1):89-107. [Medline].
Naraghi AM, White LM, Patel C, Tomlinson G, Keystone EC. Comparison of 1.0-T extremity MR and 1.5-T conventional high-field-Strength MR in patients with rheumatoid arthritis. Radiology. 2009 Jun. 251(3):829-37. [Medline].
Suzuki T, Ito S, Handa S, et al. A new low-field extremity magnetic resonance imaging and proposed compact MRI score: evaluation of anti-tumor necrosis factor biologics on rheumatoid arthritis. Mod Rheumatol. 2009. 19(4):358-65. [Medline].
Burgers LE, Nieuwenhuis WP, van Steenbergen HW, Newsum EC, Huizinga TW, Reijnierse M, et al. Magnetic resonance imaging-detected inflammation is associated with functional disability in early arthritis-results of a cross-sectional study. Rheumatology (Oxford). 2016 Sep 15. [Medline].
Wakefield RJ, Kong KO, Conaghan PG, et al. The role of ultrasonography and magnetic resonance imaging in early rheumatoid arthritis. Clin Exp Rheumatol. 2003 Sep-Oct. 21(5 Suppl 31):S42-9. [Medline].
Pearman L, Last J, Fitzgerald O, et al. Rheumatoid arthritis: a novel radiographic projection for hand assessment. Br J Radiol. 2009 Jul. 82(979):554-60. [Medline].
Gilkeson G, Polisson R, Sinclair H, et al. Early detection of carpal erosions in patients with rheumatoid arthritis: a pilot study of magnetic resonance imaging. J Rheumatol. 1988 Sep. 15(9):1361-6. [Medline].
Singson RD, Zalduondo FM. Value of unenhanced spin-echo MR imaging in distinguishing between synovitis and effusion of the knee. AJR Am J Roentgenol. 1992 Sep. 159(3):569-71. [Medline].
Sugimoto H, Takeda A, Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology. 2000 Aug. 216(2):569-75. [Medline].
Beals C, Baumgartner R, Peterfy C, Balanescu A, Mirea G, Harabagiu A, et al. Magnetic resonance imaging of the hand and wrist in a randomized, double-blind, multicenter, placebo-controlled trial of infliximab for rheumatoid arthritis: Comparison of dynamic contrast enhanced assessments with semi-quantitative scoring. PLoS One. 2017. 12 (12):e0187397. [Medline].
Jevtic V, Watt I, Rozman B, et al. Contrast enhanced Gd-DTPA magnetic resonance imaging in the evaluation of rheumatoid arthritis during a clinical trial with DMARDs. A prospective two-year follow-up study on hand joints in 31 patients. Clin Exp Rheumatol. 1997 Mar-Apr. 15(2):151-6. [Medline].
Konig H, Sieper J, Wolf KJ. Rheumatoid arthritis: evaluation of hypervascular and fibrous pannus with dynamic MR imaging enhanced with Gd-DTPA. Radiology. 1990 Aug. 176(2):473-7. [Medline].
Reiser MF, Bongartz GP, Erlemann R, et al. Gadolinium-DTPA in rheumatoid arthritis and related diseases: first results with dynamic magnetic resonance imaging. Skeletal Radiol. 1989. 18(8):591-7. [Medline].
Poleksic L, Zdravkovic D, Jablanovic D, et al. Magnetic resonance imaging of bone destruction in rheumatoid arthritis: comparison with radiography. Skeletal Radiol. 1993 Nov. 22(8):577-80. [Medline].
Black RJ, Spargo L, Schultz C, et al. Decline in hand bone mineral density indicates increased risk of erosive change in early rheumatoid arthritis. Arthritis Care Res (Hoboken). 2014 Apr. 66(4):515-22. [Medline].
Olech E, Crues JV 3rd, Yocum DE, Merrill JT. Bone marrow edema is the most specific finding for rheumatoid arthritis (RA) on noncontrast magnetic resonance imaging of the hands and wrists: a comparison of patients with RA and healthy controls. J Rheumatol. 2010 Feb. 37(2):265-74. [Medline].
Lisbona MP, Pamies A, Ares J, et al. Association of bone edema with the progression of bone erosions quantified by hand magnetic resonance imaging in patients with rheumatoid arthritis in remission. J Rheumatol. 2014 Aug. 41 (8):1623-9. [Medline].
Taniguchi D, Tokunaga D, Oda R, et al. Maximum intensity projection with magnetic resonance imaging for evaluating synovitis of the hand in rheumatoid arthritis: comparison with clinical and ultrasound findings. Clin Rheumatol. 2014 Jul. 33(7):911-7. [Medline].
Akai T, Taniguchi D, Oda R, Asada M, Toyama S, Tokunaga D, et al. Prediction of radiographic progression in synovitis-positive joints on maximum intensity projection of magnetic resonance imaging in rheumatoid arthritis. Clin Rheumatol. 2016 Apr. 35 (4):873-8. [Medline].
Schwenzer NF, Kotter I, Henes JC, et al. The role of dynamic contrast-enhanced MRI in the differential diagnosis of psoriatic and rheumatoid arthritis. AJR Am J Roentgenol. 2010 Mar. 194(3):715-20. [Medline].
Grassi W, Tittarelli E, Blasetti P, et al. Finger tendon involvement in rheumatoid arthritis. Evaluation with high- frequency sonography. Arthritis Rheum. 1995 Jun. 38(6):786-94. [Medline].
Szkudlarek M, Court-Payen M, Strandberg C, et al. Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis. Eur Radiol. 2003 Jan. 13(1):163-8. [Medline].
Hammer HB, Kvien TK, Terslev L. Ultrasound of the hand is sufficient to detect subclinical inflammation in rheumatoid arthritis remission: a post hoc longitudinal study. Arthritis Res Ther. 2017 Oct 4. 19 (1):221. [Medline].
Naredo E, Bonilla G, Gamero F. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis. 2005 Mar. 64(3):375-81. [Full Text].
Moller B, Bonel H, Rotzetter M, Villiger PM, Ziswiler HR. Measuring finger joint cartilage by ultrasound as a promising alternative to conventional radiograph imaging. Arthritis Rheum. 2009 Apr 15. 61(4):435-41. [Medline].
Cyteval C. Doppler ultrasonography and dynamic magnetic resonance imaging for assessment of synovitis in the hand and wrist of patients with rheumatoid arthritis. Semin Musculoskelet Radiol. 2009 Mar. 13(1):66-73. [Medline].
De Flaviis L, Scaglione P, Nessi R, et al. Ultrasonography of the hand in rheumatoid arthritis. Acta Radiol. 1988 Jul-Aug. 29(4):457-60. [Medline].
Fornage BD. Soft-tissue changes in the hand in rheumatoid arthritis: evaluation with US. Radiology. 1989 Dec. 173(3):735-7. [Medline].
Gibbon WW. Applications of ultrasound in arthritis. Semin Musculoskelet Radiol. 2004 Dec. 8(4):313-28. [Medline].
Snekhalatha U, Muthubhairavi V, Anburajan M, Gupta N. Ultrasound Color Doppler Image Segmentation and Feature Extraction in MCP and Wrist Region in Evaluation of Rheumatoid Arthritis. J Med Syst. 2016 Sep. 40 (9):197. [Medline].
Newman JS, Laing TJ, McCarthy CJ, Adler RS. Power Doppler sonography of synovitis: assessment of therapeutic response--preliminary observations. Radiology. 1996 Feb. 198(2):582-4. [Medline].
Hau M, Schultz H, Tony HP, et al. Evaluation of pannus and vascularization of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis by high-resolution ultrasound (multidimensional linear array). Arthritis Rheum. 1999 Nov. 42(11):2303-8. [Medline].
Teh J, Stevens K, Williamson L, Leung J, McNally EG. Power Doppler ultrasound of rheumatoid synovitis: quantification of therapeutic response. Br J Radiol. 2003 Dec. 76(912):875-9. [Medline].
Strunk J, Heinemann E, Neeck G, Schmidt KL, Lange U. A new approach to studying angiogenesis in rheumatoid arthritis by means of power Doppler ultrasonography and measurement of serum vascular endothelial growth factor. Rheumatology (Oxford). 2004 Dec. 43(12):1480-3. [Medline].
Salaffi F, Carotti M, Manganelli P, Filippucci E, Giuseppetti GM, Grassi W. Contrast-enhanced power Doppler sonography of knee synovitis in rheumatoid arthritis: assessment of therapeutic response. Clin Rheumatol. 2004 Aug. 23(4):285-90. [Medline].
Fukae J, Kon Y, Henmi M, et al. Change of synovial vascularity in a single finger joint assessed by power doppler sonography correlated with radiographic change in rheumatoid arthritis: comparative study of a novel quantitative score with a semiquantitative score. Arthritis Care Res (Hoboken). 2010 May. 62(5):657-63. [Medline].
Fiocco U, Ferro F, Vezzu M, Cozzi L, Checchetto C, Sfriso P. Rheumatoid and psoriatic knee synovitis: clinical, grey scale, and power Doppler ultrasound assessment of the response to etanercept. Ann Rheum Dis. 2005 Jun. 64(6):899-905. [Medline].
Cheung PP, Dougados M, Gossec L. Reliability of ultrasonography to detect synovitis in rheumatoid arthritis: A systematic literature review of 35 studies (1,415 patients). Arthritis Care and Research. March 2010. 62(3):323-34.
Bruno MA, Wakefield RJ. Chapter 5: Ultrasound of Rheumatoid Arthritis. Bruno MA, Mosher TJ, Gold GE. Arthritis in Color: Advanced Imaging of Arthritis. Philadelphia: Saunders-Elsevier; 2009. 96-122.

Media Gallery

Soft-tissue swelling and early erosions in the proximal interphalangeal joints in a patient with rheumatoid arthritis of the hands.
Prominent juxta-articular osteopenia in all interphalangeal joints in a patient with rheumatoid arthritis of the hands.
Well-defined bony erosions in the carpal bones and metacarpal bases in a patient with rheumatoid arthritis of the hands.
Multiple erosions with deformity of the carpal bones in a patient with rheumatoid arthritis of the hands.
Follow-up radiograph obtained after an 18-month interval in a patient with rheumatoid arthritis of the hands. Ankylosis of the carpal bones has occurred, with enlargement of the erosions.
Subluxation in the metacarpophalangeal joints, with ulnar deviation, in a patient with rheumatoid arthritis of the hands.
Subluxation at the third metacarpophalangeal joint and marginal erosions at the heads of the second to fourth metacarpals in a patient with rheumatoid arthritis of the hands.
Marked ankylosis of most of the carpal bones in a patient with rheumatoid arthritis of the hands.
Partial collapse of fused carpal bones with subluxation at the radiocarpal joint in a patient with rheumatoid arthritis of the hands.
Coronal fine-section gradient echo MR image demonstrates multiple erosions in the carpal bones and bases of the metacarpals, with pannus formation around the distal ulna.
Axial proton-density weighted MR image at the level of the radio-carpal joint shows extensive tenosynovitis involving the dorsal extensor and volar flexor tendons, with fluid in the tendon sheaths.
Axial T2-weighted fat-suppresed MR image at the level of the carpal bones shows diffuse synovial hypertrophy over the dorsal aspect (arrows), with a heterogenous appearance and adjacent fluid. Fluid is also present in the dorsal extensor tendon sheaths.
Axial T1-weighted MR image of the wrist before and after gadolinium administration shows diffuse contrast enhancement in the areas of synovial hypertrophy and thickening, over both the dorsal and volar aspects.
Illustration of the scanning technique. Photograph depicts the typical scanning technique with application of the Entos Probe to the volar (flexor) aspect of the third metacarpophalangeal joint. The technique allows visualization of the joint surfaces, flexor tendon, and synovial sheaths in patients with rheumatoid arthritis.
Amplitude color Doppler sonogram in a patient with active rheumatoid arthritis. Dorsal (extensor) surface of the second metacarpophalangeal joint is imaged. Intense-amplitude Doppler color flow signal demarcates the inflamed synovium (ie, joint pannus) resulting from severe hyperemia. Solid arrows indicate the extensor tendon sheath and dorsal and volar margins. Straight open arrow indicates the synovium of the joint overlying the proximal phalanx of the second digit. Curved open arrow indicates the inflamed synovium overlying the metacarpal. The asterisk indicates a small amount of anechoic fluid in the joint space.
Power Doppler image shows hyperemic blood flow in the flexor tendon sheath in a patient with rheumatoid arthritis of the hands.
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.

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Author

Ian Y Y Tsou, MBBS, FRCR Clinical Lecturer in Diagnostic Radiology, Faculty of Medicine, National University of Singapore; Consulting Staff, Department of Radiology, MRI Centre, Radiologic Clinic, Mount Elizabeth Medical Centre, Mount Elizabeth Hospital and East Shore Hospital

Ian Y Y Tsou, MBBS, FRCR is a member of the following medical societies: Royal College of Radiologists

Disclosure: Nothing to disclose.

Coauthor(s)

Wilfred CG Peh, MD, MHSc, MBBS, FRCP(Glasg), FRCP(Edin), FRCR Clinical Professor, Yong Loo Lin School of Medicine, National University of Singapore; Senior Consultant and Head, Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Alexandra Health, Singapore

Wilfred CG Peh, MD, MHSc, MBBS, FRCP(Glasg), FRCP(Edin), FRCR is a member of the following medical societies: American Roentgen Ray Society, British Institute of Radiology, International Skeletal Society, Radiological Society of North America, Royal College of Physicians, Royal College of Radiologists

Disclosure: Nothing to disclose.

Michael A Bruno, MD, MS, FACR Professor of Radiology and Medicine, Pennsylvania State University College of Medicine; Director, Radiology Quality Management Services, The Penn State Milton S Hershey Medical Center

Michael A Bruno, MD, MS, FACR is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging, Society of Skeletal Radiology

Disclosure: Received royalty from Oxford Press for book author/editor & reviewer; Received royalty from Elsevier Press for book author / editor.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Lynne S Steinbach, MD Professor of Radiology and Orthopedic Surgery, University of California, San Francisco, School of Medicine

Lynne S Steinbach, MD is a member of the following medical societies: American College of Radiology, International Skeletal Society, Radiological Society of North America

Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, MEd Professor, Department of Radiology, Vice Chairman for Academic Innovation, Section Head of Musculoskeletal Radiology, University of Washington School of Medicine

Felix S Chew, MD, MBA, MEd is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America

Disclosure: Nothing to disclose.

Additional Contributors

Amilcare Gentili, MD Professor of Clinical Radiology, University of California, San Diego, School of Medicine; Consulting Staff, Department of Radiology, Thornton Hospital; Chief of Radiology, San Diego Veterans Affairs Healthcare System

Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, Society of Skeletal Radiology

Disclosure: Nothing to disclose.

What is the degree of confidence in the use of had radiographs in the diagnosis of rheumatoid arthritis (RA)?

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