Tenosynovitis in the Forefoot at Disease Presentation Is Specific for RA: Results from a Cross-Sectional MRI Study in Early Arthritis

Yousra J. Dakkak¹, Debbie M. Boeters², Annette H.M. van der Helm-van Mil² and M. Reijnierse³, ¹Rheumatology, Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ³Department of Radiology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Early Rheumatoid Arthritis, foot, inflammation and rheumatoid arthritis (RA), MRI

Session Information

Date: Monday, November 6, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster II: Pathophysiology, Autoantibodies, and Disease Activity Measures

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

The foot is a preferential location for rheumatoid arthritis (RA)-manifestation, but physical examination of the metatarsophalangeal (MTP) joints is difficult. Magnetic Resonance Imaging (MRI) is sensitive in depicting inflammation at an early stage; it detects synovitis, bone marrow edema (BME) and tenosynovitis. MRI detected inflammation in the MTP joints has not been studied thoroughly in an early arthritis setting, but may increase our understanding of forefeet inflammation. This cross-sectional MRI study thoroughly examined the forefoot to identify inflammatory findings that are specific for RA compared to other arthritides.

Methods:

218 patients presenting with early arthritis (93 RA, 125 other arthritides) underwent contrast-enhanced 1.5T MRI of unilateral MTP 1-5-joints. BME, synovitis and tenosynovitis were scored by two readers according to OMERACT rheumatoid arthritis MRI scoring system (RAMRIS), and Haavardsholm et al. Comparisons between RA and other arthritides were made at joint level.

Results:

1090 MTP-joints were studied. RA-patients more often had MRI-detected inflammation in any of the MTP-joints than other arthritides (74 vs 61%, p=0.038). Tenosynovitis was associated with RA; the association was strongest for MTP 5 (OR 12.8, 95% CI 2.9-57.1), followed by MTP 1 (OR 3.1, 95% CI 1.3-7.3). Inflammation in RA was present at both the flexor and extensor tendons. The specificity of tenosynovitis was high, ranging between 89-98% at the different MTPs. The sensitivity for RA ranged 16-19%.

In addition, BME in MTP 3-5 was associated with RA, as well as synovitis in MTP 3-5. Of these joints, MTP 5 showed the strongest associations (BME: OR 5.2, 95% CI 2.1-12.9, synovitis: OR 6.0, 95% CI2.8-13.1).

Conclusion:

MRI detected inflammation including BME, synovitis and tenosynovitis was increased at the level of MTP 5 joints of RA patients, this is in line with MTP 5 being a preferential location for erosion development. Previous studies have shown that tenosynovitis in wrist and MCP joints is associated with RA; the present study is the first demonstrating in an early arthritis setting that tenosynovitis in MTP joints is also specific for RA.

Disclosure: Y. J. Dakkak, None; D. M. Boeters, None; A. H. M. van der Helm-van Mil, None; M. Reijnierse, None.

To cite this abstract in AMA style:

Dakkak YJ, Boeters DM, van der Helm-van Mil AHM, Reijnierse M. Tenosynovitis in the Forefoot at Disease Presentation Is Specific for RA: Results from a Cross-Sectional MRI Study in Early Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/tenosynovitis-in-the-forefoot-at-disease-presentation-is-specific-for-ra-results-from-a-cross-sectional-mri-study-in-early-arthritis/. Accessed .

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/tenosynovitis-in-the-forefoot-at-disease-presentation-is-specific-for-ra-results-from-a-cross-sectional-mri-study-in-early-arthritis/