MR-morphological changes of the metacarpophalangeal joints in patients with rheumatoid arthritis: Comparison of early and chronical stages.
Purpose: Evaluation of MRI findings in the metacarpophalangeal (MCP) joints in patients with early (eRA) and chronical rheumatoid arthritis (cRA).
Material and methods: In 22 RA patients (9 with disease duration </= 1.5 years = eRA) the dominant hands were examined by MRI in coronal T(2) weighted turbo-spin-echo (TSE). T(1) weighted spin-echo (SE) sequences before and after injection of Gd-DTPA and fat-suppressed short tau inversion recovery (STIR) sequences, followed by miniarthroscopy (MA) of the MCP II joint after an interval of 24 hours. MRI and MA findings were assessed using standardised semiquantitative items of synovial and bony pathologies and a statistical comparison between eRA and cRA patients was performed.
Results: In MRI synovial proliferation was detected in 13/13 cRA and 8/9 eRA patients. It was statistically not significant; the degree of synovial proliferation was however lower in the eRA group. All eRA patients with synovial changes showed enhancement after administration of contrast medium, a marker which correlated with the clinical activity. In 2/13 cRA patients no uptake of contrast medium was evident. Bony erosions and strongly narrowing joint space correlated with disease duration and were documented significantly rarer in the eRA patients (1/9, 2/9) than in the cRA patients (9/13, 10/13).
Conclusion: In RA patients, MRI of the metacarpophalangeal joints can detect specific pathological changes which are observed significantly more often in either early or chronic stages and which are associated with disease activity and duration.