Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea.
Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea.
Korean J Intern Med. 2019 May;34(3):651-659. doi: 10.3904/kjim.2016.271. Epub 2017 Nov 24.
BACKGROUND/AIMS: Magnetic resonance imaging (MRI) is a sensitive and useful method for the detection of synovitis and joint destruction in rheumatoid arthritis (RA) patients. However, the patterns of MRI-detected bone erosion, bone marrow edema (BME), synovitis, and tenosynovitis have received insufficient attention. Therefore, this study evaluated the patterns of bone erosion, BME, synovitis, and tenosynovitis, and calculated the RA-MRI score (RAMRIS) of patients with RA at the carpal and metacarpophalangeal (MCP) joints using MRI.
MRI datasets from 43 RA patients were analyzed. All patients had undergone MRI of one wrist. In addition, 36 patients had MCP joint images taken, and three had also received MRI of the contralateral wrist and MCP joints. The MR images were evaluated for bone erosion, BME, and synovitis in consensus by two blinded readers according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RAMRIS. The MRI-detected tenosynovitis was evaluated based on Haavardsholm's tenosynovitis score.
The capitate, lunate, triquetrum, and hamate bones were the most common sites of erosion and BME and showed the highest RAMRIS erosion and BME scores. Moreover, MRI-detected tenosynovitis was present in 78.3% of all patients with RA, and the extensor compartment 4 and flexor digitorum profundus and superficialis were frequently affected.
This study identified the distribution and prevalence of MRI-detected bone erosion, BME, synovitis, and tenosynovitis of the wrist and MCP joints in RA patients. The patterns of the MRI-detected abnormalities may help to select sites for the application of MRI protocols in clinical trials and practice.
背景/目的：磁共振成像（MRI）是一种敏感且有用的方法，可用于检测类风湿关节炎（RA）患者的滑膜炎和关节破坏。然而，MRI 检测到的骨侵蚀、骨髓水肿（BME）、滑膜炎和腱鞘炎的模式尚未得到充分关注。因此，本研究评估了 RA 患者腕关节和掌指关节（MCP）的 MRI 检测到的骨侵蚀、BME、滑膜炎和腱鞘炎模式，并计算了 RA-MRI 评分（RAMRIS）。
分析了 43 例 RA 患者的 MRI 数据集。所有患者均接受了一只手腕的 MRI 检查。此外，36 例患者接受了 MCP 关节图像检查，3 例患者还接受了对侧手腕和 MCP 关节的 MRI 检查。两名盲法读者根据风湿病临床疗效测量（OMERACT）RAMRIS 共识评估了骨侵蚀、BME 和滑膜炎。根据 Haavardsholm 的腱鞘炎评分评估了 MRI 检测到的腱鞘炎。
头状骨、月骨、三角骨和钩骨是侵蚀和 BME 最常见的部位，且具有最高的 RAMRIS 侵蚀和 BME 评分。此外，78.3%的 RA 患者存在 MRI 检测到的腱鞘炎，伸肌鞘 4 和指深、浅屈肌常受累。
本研究确定了 RA 患者腕关节和 MCP 关节的 MRI 检测到的骨侵蚀、BME、滑膜炎和腱鞘炎的分布和流行情况。MRI 检测到的异常模式可能有助于在临床试验和实践中选择 MRI 方案的应用部位。
