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MRI-Based Synovial Iron Quantification Associates with Bone Erosion in Rheumatoid Arthritis.

Shuyuan Zhong1, Churong Lin2, Jianhua Ren3

  • 1Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.

Biomedicines
|May 4, 2026
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Summary

Magnetic resonance imaging (MRI) can quantify synovial iron in rheumatoid arthritis (RA) patients. This iron level, measured by R2* values, correlates with bone erosion severity, offering a potential non-invasive biomarker for joint damage.

Keywords:
bone erosionkneemagnetic resonance imaging (MRI)quantificationrheumatoid arthritisrisk factorssynovial iron

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Area of Science:

  • Orthopedics
  • Radiology
  • Rheumatology

Background:

  • Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint damage.
  • Assessing structural joint damage in RA, particularly bone erosion, is crucial for effective management.
  • Non-invasive imaging biomarkers are needed to quantify disease activity and structural damage.

Purpose of the Study:

  • To evaluate the utility of synovial iron quantification using Magnetic Resonance Imaging (MRI) in assessing knee joint structural damage in RA patients.
  • To investigate the association between synovial R2* values and clinical parameters, including disease activity and bone erosion.
  • To develop and validate an R2*-based nomogram for predicting bone erosion severity.

Main Methods:

  • A cross-sectional study involving patients with RA and osteoarthritis (OA).
  • Synovial iron content was quantified using R2* values derived from IDEAL-IQ MRI sequences.
  • Associations between R2* values and clinical/laboratory parameters, including bone erosion, were analyzed using correlation and regression models.

Main Results:

  • Synovial R2* values were significantly higher in RA patients compared to OA patients.
  • R2* values showed a positive correlation with bone erosion severity and a negative association with joint space width.
  • R2* was identified as an independent predictor of bone erosion extent, with a high discriminative performance in the developed nomogram.

Conclusions:

  • R2* value derived from IDEAL-IQ MRI is a reliable tool for quantifying synovial iron in RA patients.
  • Synovial iron quantification using MRI may serve as a promising non-invasive imaging biomarker for reflecting bone erosion in RA.
  • This imaging technique could aid in monitoring disease progression and treatment response in RA.