Background/Purpose: In the articles of 2010 rheumatoid arthritis (RA) classification criteria, it is stated that additional evidence of joint injury from other imaging techniques such as magnetic resonance imaging (MRI) may be used for confirmation of the clinical findings. Considering the impact of MRI on the clinical assessment of inflammatory arthritides, it would be desirable to address the algorithm toward earlier classification of RA by the  MRI findings combining to 2010 RA classification criteria. We have tried to investigate whether MRI-proven joint injury assist the diagnostic performance of 2010 RA classification criteria toward early arthritis patients.

Methods: Two hundred patients with early arthritis patients, whose median duration of symptoms at entry is 3 months, were consecutively enrolled into this study. Patients, whose diagnoses were compatible as other rheumatic diseases than RA or obvious to plain radiographic erosion at entry, were excluded in the present study. All of the patients were examined by Japan College of Rheumatology (JCR)-certified rheumatologists and considered as RA potentially at entry. Patients gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University. All of the subjects had been examined by physical examination, blood tests, gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MRI and plain radiograph of both wrist and finger joints at the same day. Gold standard RA in the present study was defined as the patients received disease-modifying antirheumatic drugs (DMARDs) therapy during the first year. Patients were evaluated by the 2010 RA classification criteria at the initial visit. Diagnostic performance of 2010 RA criteria combined with or without the finding of MRI-proven joint injury were investigated. One hundred fifteen were diagnosed as gold standard RA whereas 85 were not.

Results: 2010 RA classification criteria classified RA at sensitivity 59.8 %, specificity 80.7 %, positive predictive value (PPV) 81.4 %, respectively. Osteitis was the most specific MRI finding toward gold standard RA (sensitivity 45.3 %, specificity 90.4 %, PPV 86.9 %) as compared with symmetrical synovitis and bone erosion. We have proposed the decision tree algorithm of 2010 RA classification criteria combined with MRI-proven osteitis which demonstrate initially applied 2010 RA classification criteria, and if the patients do not fulfill 2010 RA classification criteria, MRI-proven osteitis rule is introduced. The tree algorithm has shown to differentiate the patients more efficiently compared with 2010 RA classification criteria alone as sensitivity 74.4 %, specificity 94.0 %, PPV 94.6 %, respectively.

Conclusion: The present data indicate that combination of MRI-proven osteitis with 2010 RA classification criteria improves the diagnostic probability of RA at earlier stage.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/combination-of-magnetic-resonance-imaging-mri-proven-osteitis-with-2010-ra-classification-criteria-improves-the-diagnostic-probability-of-rheumatoid-arthritis-ra/