Asunto(s)
Antirreumáticos/uso terapéutico , Gota/tratamiento farmacológico , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Relación Dosis-Respuesta a Droga , Glucocorticoides/uso terapéutico , Humanos , Interleucina-1/antagonistas & inhibidores , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of this study was to compare the relative results from conventional high-field-strength 1.5-T MRI, 0.2-T low-field-strength dedicated extremity MRI, and radiography to detect and grade bone erosions, joint-space narrowing, and synovitis in the hands and wrists of patients with rheumatoid arthritis. SUBJECTS AND METHODS: Eighteen patients with rheumatoid arthritis underwent conventional high-field-strength MRI, low-field-strength dedicated extremity MRI, and conventional radiography of both hands and wrists. Two independent reviewers searched for the presence and extent of bone erosions, joint-space narrowing, and synovitis. Bone erosions (E scores) and joint-space narrowing (J scores) were evaluated at 14 and 13 sites, respectively, on conventional high-field-strength MRI, low-field-strength dedicated extremity MRI, and radiography, using the Sharp-Genant scoring system. Synovitis (S scores) were evaluated at 13 sites on conventional high-field-strength MRI and low-field-strength dedicated extremity MRI. RESULTS: For the detection of bone erosions, we found no significant difference (p = 0.71) between conventional high-field-strength MRI (mean +/- SD E score, 27.5 +/- 9.8) and low-field-strength dedicated extremity MRI (28.8 +/- 10.0), but a significant difference (p < 0.001) appeared between MRI and radiography (13.1 +/- 8.3). J scores derived from MRI (conventional high-field-strength MRI, 15.2 +/- 8.3; low-field-strength dedicated extremity MRI, 14.5 +/- 10.4) were higher than those derived from radiography (12.7 +/- 9.6), although the difference was not significant (p = 0.70). Conventional high-field-strength MRI (S score, 35.1 +/- 8.6) and low-field-strength dedicated extremity MRI (30.8 +/- 10.2) were equivalent (p = 0.14) for the evaluation of synovitis. The interobserver agreement for MRI scores was good to excellent (intraclass correlation coefficients, 0.83-0.94). CONCLUSION: Conventional high-field-strength MRI and low-field-strength dedicated extremity MRI showed similar results in terms of cross-sectional grading of bone erosions, joint-space narrowing, and synovitis in the hands and wrists of patients with rheumatoid arthritis.
Asunto(s)
Artritis Reumatoide/diagnóstico , Resorción Ósea/diagnóstico , Articulaciones de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/patología , Sinovitis/diagnóstico , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/patología , Adulto , Anciano , Artritis Reumatoide/complicaciones , Resorción Ósea/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Radiografía , Índice de Severidad de la Enfermedad , Sinovitis/etiologíaRESUMEN
Rheumatoid arthritis can cause joint erosion and deformity, pain, stiffness, and decreased function and range of motion. Early diagnosis is crucial to prevent permanent joint damage. In this article, Drs Williams and Fye discuss articular and extra-articular manifestations of rheumatoid arthritis as well as the evolving treatment approaches to this complex disease.