Evaluating MRI-Detected Tenosynovitis of the Hand and Wrist in Early Arthritis

W.P. Nieuwenhuis¹, A. Krabben¹, W. Stomp², T. W. J. Huizinga¹, D. M. van der Heijde¹, J.L Bloem², M. Reijnierse³ and A.H.M. van der Helm-van Mil¹, ¹Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²Radiology, Leiden University Medical Center, Leiden, Netherlands, ³Leiden University Medical Center, Leiden, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Early Rheumatoid Arthritis, Magnetic resonance imaging (MRI), rheumatoid arthritis (RA) and tendonitis/bursitis

Session Information

Title: Imaging of Rheumatic Diseases: Magnetic Resonance Imaging (MRI)

Session Type: Abstract Submissions (ACR)

Background/Purpose

Magnetic resonance imaging (MRI) is a sensitive method to detect local inflammation in rheumatoid arthritis (RA), visualizing synovitis, bone marrow edema and tenosynovitis. The prevalence of MRI-detected tenosynovitis and the diagnostic value in early arthritis are unclear. This study aimed to identify the frequency of MRI-detected tenosynovitis at the metacarpophalangeal (MCP) and wrist joints in early arthritis and the association with RA and severity features within RA.

Methods

178 early arthritis patients underwent unilateral 1.5T extremity-MRI at baseline. The MCP and wrist-joints were scored using the RA MRI scoring (RAMRIS) system extended with Haavardsholms tenosynovitis score. 69 patients fulfilled the 2010 RA classification criteria during the first year and were compared with the other patients. Within RA-patients comparisons were made for anti-citrullinated-peptide-antibody (ACPA) positivity and for radiographic progression during year-1.

Results

65% of all patients had MRI-detected tenosynovitis. RA-patients had tenosynovitis more often than non-RA patients (75% versus 59%, p=0.023). The flexor tendons at MCP-5, the extensor tendons at MCP-2 and MCP-4 and extensor compartment-I of the wrist were more frequently affected in RA than in other diagnoses (odds ratio’s 2.8 (95% confidence interval (CI) 1.2-7.0), 9.1 (95% CI 1.9-42.8), 14.2 (95% CI 1.7-115.9), 4.0 (95% CI 1.4-11.1) respectively). These associations were independent of local MRI-detected synovitis. Specificities were all ≥82%. Within RA, tenosynovitis-scores were not associated with ACPA-positivity or radiographic progression.

Conclusion

MRI-detected tenosynovitis is common in early arthritis. The flexor tendons at MCP-5, the extensor tendons at MCP-2 and MCP-4 and the first extensor compartment of the wrist are more often affected in RA, independent of local synovitis.

Disclosure:

W. P. Nieuwenhuis,
None;

A. Krabben,
None;

W. Stomp,
None;

T. W. J. Huizinga,
None;

D. M. van der Heijde,
None;

J. L. Bloem,
None;

M. Reijnierse,
None;

A. H. M. van der Helm-van Mil,
None.

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