Hand Osteoarthritis: MRI Predicts Progression

Veronica Hackethal, MD

September 17, 2014

Magnetic resonance imaging (MRI) findings can be used to predict radiographic progression of hand osteoarthritis, according to a study published online September 9 in the Annals of Rheumatic Diseases.

The Oslo Hand Osteoarthritis cohort is the first longitudinal study that has used MRI data to study hand osteoarthritis.

"With imaging modalities, we were able to identify patients who are most likely to progress. In our study, inflammation, bone marrow lesions, and joint space narrowing could significantly predict radiographic progression over 5 years," first author Ida K. Haugen, MD, PhD, from the Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, told Medscape Medical News.

Osteoarthritis is thought to affect the whole joint, not just the cartilage, according to Dr. Haugen. MRI, which is not currently recommended for evaluating hand osteoarthritis in routine clinical practice, has the advantage over other imaging modalities of visualizing the whole joint, she added. Synovitis and soft tissue swelling associated with inflammation can be assessed on clinical exam and with ultrasound. Conventional X-rays can be used to evaluate joint space narrowing. But only MRI can visualize bone marrow lesions, according to Dr. Haugen.

Most research to date has looked at osteoarthritis of the knees, and scientists have limited knowledge about osteoarthritis of the hands. The Oslo Hand Osteoarthritis Cohort study is "important," Dr. Haugen pointed out, because it will add to our knowledge about the natural history and risk factors for disease progression in hand osteoarthritis.

"Unfortunately, no disease-modifying treatment is available, and patients are therefore treated with symptom-modifying treatment with little to moderate effect, if any," Dr. Haugen emphasized. "Future studies are needed in order to explore whether treating synovitis with noninflammatory drugs, for example, leads to less radiographic progression."

Dr. Haugen and colleagues followed 74 participants for 5 years. Included participants had a mean age of 67.9 years and had data available for MRI of the dominant hand and bilateral hand X-rays at baseline (between 2008 and 2009) and at follow-up (2013). The researchers looked at 3 aspects of radiographic progression: joint space narrowing as a measure of cartilage loss, Kellgren-Lawrence scores as an indication of increasing overall osteoarthritis severity, and development of new joint erosions.

Only a single reader evaluated the MRI data, which could have limited the study. The reader, however, was blinded to clinical and other imaging information, the authors note. In addition, researchers used frontal hand X-rays, which could underestimate the amount of osteoarthritis progression.

More than 50% of participants had severe hand osteoarthritis, and 56.8% had erosive disease. Erosions developed in 9.1% of those without erosions at baseline. Of participants with joint space narrowing at baseline, 17.0% showed radiographic progression on follow-up. Among those with bone marrow lesions at baseline, 24.1% showed radiographic progression.

The results suggest that both inflammation and mechanical stresses on the joint play a role in the progression of hand osteoarthritis. MRI visualization at baseline of synovitis (odds ratio [OR], 3.52; 95% confidence interval [CI], 1.29 - 9.59), bone marrow lesions (OR, 2.73; 95% CI, 1.29 - 5.78), and joint space narrowing (OR, 11.05; 95% CI, 3.22 - 37.90) predicted progression of joint space narrowing. Increasing Kellgren scores and development of new joint erosions followed a similar pattern. Malalignment had the "strongest" association in the case of new joint erosions (OR, 10.18; 95% CI, 2.01 - 51.64).

Although the study provides support for using MRI as a research tool, its results will likely have "zero effect on clinical practice," Gregory Middleton, MD, told Medscape Medical News. Dr. Middleton is a rheumatologist and associate clinical professor of medicine in the Department of Orthopaedic Surgery at the University of California, San Diego. He was not involved with the study.

"This study basically confirms what we know clinically," Dr. Middleton commented. "Patients with worse disease at baseline have worse disease in the future."

"Unfortunately, studies to date have not shown any benefit of treating the inflammation in hand osteoarthritis," Dr. Middleton concluded. "I would not recommend hand MRI as a clinical practice tool, since we cannot yet alter the course of the disease of those most at risk."

The authors and Dr. Middleton have disclosed no relevant financial relationships.

Ann Rheum Dis. Published online September 9, 2014. Abstract


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