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Older age is associated with more MRI-detected inflammation in hand and foot joints
Wouter P Nieuwenhuis1, Lukas Mangnus2, Hanna W van Steenbergen2
1Department of Rheumatology W.P.Nieuwenhuis@lumc.nl.
Objectives:
Although MRI is recommended for diagnostic use in detecting joint inflammation, its value in clinical practice has not been settled. Older symptom-free persons show more MRI-detected inflammation in their hands and feet. Within arthritis patients, a similar effect could be present (a general age effect). The association of age with MRI inflammation could also be enhanced by disease (disease-dependent age effect). Because both effects could have diagnostic consequences, we evaluated the association between age-at-onset and MRI-detected inflammation in early arthritis and RA.
Methods:
Unilateral contrast-enhanced MRI of the MCP joint, wrist and MTP joints was performed in 589 newly presenting early arthritis patients, of whom 229 had RA. Bone marrow oedema, synovitis and tenosynovitis were summed, yielding the MRI inflammation score. MRI findings were associated with age and compared with those of 193 (previously reported) symptom-free controls.
Results:
Early arthritis and RA-patients had, respectively, 2.6 (95% CI: 2.3, 3.0, P < 0.001) and 3.7 times (95% CI: 3.2, 4.3, P < 0.001) higher MRI inflammation scores than controls (adjusted for age). At higher age of onset, early arthritis and RA patients had higher MRI inflammation scores (1.03/year, P < 0.001). A similar effect was observed in controls (1.03/year, P < 0.001). The interaction term age*group (arthritis/RA vs controls) was non-significant (P = 0.80 and P = 0.23), suggesting that the age effect was not disease dependent. At the joint level, older RA patients had more extended MRI inflammation, but the preferential locations were similar.
Conclusion:
Older age is associated with more MRI-detected inflammation, and the effect was similar in arthritis and controls. This age effect should be considered when interpreting hand and foot MRI for diagnostic purposes.
Insights
Older age is linked to increased MRI-detected joint inflammation in both arthritis patients and healthy individuals. This general age effect, not specific to disease, is crucial for accurate MRI interpretation in diagnostics.
Area of Science:
- Rheumatology
- Radiology
- Medical Imaging
Background:
- Magnetic Resonance Imaging (MRI) is recommended for detecting joint inflammation, but its clinical utility requires further validation.
- Previous studies indicate higher MRI-detected inflammation in older asymptomatic individuals.
- The influence of age on MRI inflammation in early arthritis and Rheumatoid Arthritis (RA) needs clarification, considering potential disease-specific effects.
Purpose of the Study:
- To investigate the association between age at onset and MRI-detected inflammation in early arthritis and RA patients.
- To determine if the age-related increase in MRI inflammation differs between arthritis patients and controls.
- To assess the diagnostic implications of age on MRI interpretation for joint inflammation.
Main Methods:
- Contrast-enhanced MRI of the MCP, wrist, and MTP joints was performed on 589 early arthritis patients (229 with RA) and 193 controls.
- MRI inflammation scores were calculated by summing bone marrow edema, synovitis, and tenosynovitis.
- Findings were analyzed for associations with patient age and compared between patient groups and controls.
Main Results:
- Early arthritis and RA patients exhibited significantly higher MRI inflammation scores compared to controls, even after age adjustment.
- A positive association was found between age at onset and MRI inflammation scores in both arthritis patients and controls.
- The age effect on MRI inflammation was consistent across patient groups and controls, indicating a non-disease-dependent association.
Conclusions:
- Older age is independently associated with increased MRI-detected joint inflammation.
- This age-related effect is similar in individuals with early arthritis, RA, and healthy controls.
- Consideration of patient age is essential for the accurate diagnostic interpretation of hand and foot MRI findings.
