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Finger joint synovitis in rheumatoid arthritis: quantitative assessment by magnetic resonance imaging
M Klarlund1, M Ostergaard, I Lorenzen
1Department of Rheumatology, Danish Research Centre of Magnetic Resonance, Hvidovre Hospital, University of Copenhagen, Denmark.
Objective:
To assess quantitatively, by magnetic resonance imaging (MRI), the synovial membrane volume in second to fifth metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis and healthy controls, and to compare the synovial membrane volumes with a more easily obtained semi-quantitative score for hypertrophic synovial membrane.
Patients And Methods:
MCP joints of the dominant hand of 37 patients and five controls were examined clinically and by MRI. Laboratory assessments were performed.
Results:
Median synovial membrane volumes were considerably larger in clinically active rheumatoid arthritis (RA) joints (e.g. 0.97 ml in the second MCP joint) than in clinically inactive joints (0.54 ml) and control joints (0.04 ml). Nevertheless, group distributions overlapped and marked volume differences were found within clinically uniform groups. The semi-quantitative score was highly correlated with the synovial volumes (Spearman rho = 0.79; P < 0.00001). Synovial membrane volumes were poorly related to the presence of rheumatoid factor and to laboratory markers of inflammation.
Conclusion:
These findings suggest that synovial membrane volumes, as determined by MRI, in finger joints are related to clinical signs of synovitis, but also that the volumes may vary more than what can be accounted for by the clinical appearances. A semi-quantitative score may be sufficient for more routine purposes.
Insights
Magnetic resonance imaging (MRI) reveals larger synovial membrane volumes in rheumatoid arthritis (RA) finger joints compared to controls. A semi-quantitative score correlates well with these volumes for clinical assessment.
Area of Science:
- Rheumatology
- Medical Imaging
- Orthopedics
Background:
- Rheumatoid arthritis (RA) is characterized by synovial membrane inflammation.
- Accurate assessment of synovial hypertrophy is crucial for RA management.
- Magnetic resonance imaging (MRI) offers detailed visualization of joint structures.
Purpose of the Study:
- To quantitatively assess synovial membrane volume in metacarpophalangeal (MCP) joints of RA patients and healthy controls using MRI.
- To compare MRI-derived synovial volumes with a semi-quantitative scoring system.
- To explore the relationship between synovial volume and clinical/laboratory markers of inflammation.
Main Methods:
- MRI of the dominant hand's second to fifth MCP joints in 37 RA patients and 5 controls.
- Clinical examination and laboratory assessments were performed concurrently.
- Synovial membrane volumes were measured quantitatively via MRI.
Main Results:
- Synovial membrane volumes were significantly larger in active RA joints (0.97 ml) compared to inactive RA joints (0.54 ml) and control joints (0.04 ml).
- A high correlation was observed between MRI-derived synovial volumes and a semi-quantitative score (Spearman rho = 0.79, P < 0.00001).
- Synovial volumes showed weak associations with rheumatoid factor and inflammatory markers.
Conclusions:
- MRI-determined synovial membrane volumes in finger joints correlate with clinical synovitis in RA.
- Synovial volume variability may exceed clinical assessment, suggesting MRI's detailed insights.
- A semi-quantitative score appears adequate for routine clinical evaluation of synovial hypertrophy.