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Updated: May 15, 2026
Erosion Identification in Metacarpophalangeal Joints in Rheumatoid Arthritis using High-Resolution Peripheral Quantitative Computed Tomography
Published on: October 6, 2023
Characterisation of hand small joints arthropathy using high-resolution MRI--limited discrimination between
Leonie S Braum1, Dennis McGonagle, Anne Bruns
1Department of Radiology, Charité Medical School, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
Objective:
To test the hypothesis that microanatomical differences in joint disease localisation could be exploited using high-resolution MRI to better differentiate among rheumatoid arthritis (RA), spondyloarthritis/psoriatic arthritis (SpA/PsA) and osteoarthritis (OA) in clinical practice.
Methods:
Sixty-nine patients with suspected inflammatory joint disease of the hand or feet underwent high-resolution MRI using a small loop coil. Images were scored blinded to the clinical status. Various joint changes like periostitis, osteitis, erosions, enthesitis and synovitis were recorded. The image-based diagnosis was compared with the clinical diagnosis.
Results:
In 59.4 % of the patients the clinical diagnosis was confirmed on image analysis. This was high for OA (80 %), moderately good for RA (67 %) but only 50 % for SpA/PsA. The major difficulty was to distinguish OA from SpA/PsA where common imaging findings are evident including periostitis (SpA/PsA 45 %, OA 40 % compared with RA 0 %; P = 0.015). Likewise, osteitis was frequently detected in SpA/PsA (79 %) and OA (80 %) and less frequently in RA (42 %) (P = 0.014).
Conclusion:
Characterisation of inflammatory disorders of small joints merely using high-resolution MRI remains challenging especially in the differentiation between OA and PsA. These findings are likely explained by common microanatomical similarities in disease expression rather than limitations of imaging techniques.
Key Points:
• High-resolution MRI is increasingly used to investigate joint disease. • Osteitis and periostitis occur in psoriatic and osteoarthritis (but not rheumatoid arthritis). • In severely affected patients the amount of synovitis and erosions is similar.
Insights
High-resolution MRI shows promise for diagnosing joint diseases like rheumatoid arthritis (RA), psoriatic arthritis (PsA), and osteoarthritis (OA). However, differentiating OA from PsA using imaging remains challenging due to overlapping microanatomical features.
Area of Science:
- Rheumatology
- Radiology
- Medical Imaging
Background:
- High-resolution magnetic resonance imaging (MRI) is a valuable tool for assessing joint diseases.
- Distinguishing between inflammatory and degenerative joint conditions is crucial for effective patient management.
- Rheumatoid arthritis (RA), spondyloarthritis/psoriatic arthritis (SpA/PsA), and osteoarthritis (OA) present with overlapping clinical and imaging features.
Purpose of the Study:
- To evaluate the efficacy of high-resolution MRI in differentiating between RA, SpA/PsA, and OA based on microanatomical joint disease localization.
- To determine if specific imaging patterns can reliably distinguish these conditions in clinical practice.
Main Methods:
- Sixty-nine patients with suspected inflammatory joint disease underwent high-resolution MRI of the hand or feet.
- Images were analyzed by blinded radiologists who recorded various joint changes, including periostitis, osteitis, erosions, enthesitis, and synovitis.
- Image-based diagnoses were compared with the final clinical diagnoses.
Main Results:
- High-resolution MRI confirmed the clinical diagnosis in 59.4% of patients, with higher accuracy for OA (80%) and RA (67%) compared to SpA/PsA (50%).
- A significant challenge was differentiating OA from SpA/PsA, as both conditions frequently exhibited osteitis (OA 80%, SpA/PsA 79%) and periostitis (OA 40%, SpA/PsA 45%).
- Rheumatoid arthritis (RA) showed distinct patterns, with 0% reporting periostitis and lower rates of osteitis (42%).
Conclusions:
- High-resolution MRI alone is currently insufficient to reliably differentiate between osteoarthritis (OA) and psoriatic arthritis (PsA) due to shared microanatomical disease manifestations.
- The imaging technique shows potential but requires further refinement for precise diagnosis of inflammatory arthropathies.
- Osteitis and periostitis are key imaging findings that can be present in both OA and SpA/PsA, complicating differential diagnosis from RA.
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