Imaging in rheumatoid arthritis - USG & MRI - two articles

For those specifically interested in this subject, there are two articles in the July issue of Arthritis Rheum.

One article by Szkudlarek M et al compares the role of USG in the evaluation of MCP joints in patients with RA using MRI as a gold standard. Their conclusion: "US enables detection and grading of destructive and inflammatory changes in the MTP joints of patients with RA. By comparison with MRI, US was found to be markedly more sensitive and accurate than clinical examination and conventional radiography. Considering the early and frequent involvement of the MTP joints, evaluation of these joints by US may be of major clinical importance in RA".

Some of our rheumatologists have been trying to use USG for this purpose; the only problem is that it is a tedious procedure and takes a lot of time.

The other article is even more interesting. Ostendorf B et al performed hand and wrist MRI scans on 25 patients with early RA. Those who had normal studies (10/25) had an MRI of the dominant foot. All these were abnormal. Their conclusion therefore is "RAMRIS analysis of MRI scans of the forefeet detected synovitis and bone edema in patients with early RA in whom MRI of the finger joints was normal. MRI of the forefeet contributes an additional tool aimed at earlier and more accurate diagnosis and thus might allow an earlier decision to start appropriate medication in patients with early RA."

This again adds to the growing literature on the use of MRI for the diagnosis and staging of patients with RA. Though not yet accepted by rheumatologists in our country (cost, etc), MRI of the hands and wrist with contrast allows both the early and accurate diagnosis of RA as well as prognosis and follow-up. MRI is currently the gold-standard in drug trials for assessing response to treatment.