ROLE OF MRI AND ULTRASOUND IN THE ASSESSMENT OF RHEUMATOID ARTHRITIS IN THE HAND AND WRIST JOINTS

Abstract

Rheumatoid arthritis is characterized by proliferative, hypervascularized synovitis, resulting in bone erosion, cartilage damage, joint destruction, and long-term disability. Diagnosis is based on clinical, laboratory, and radiographic findings. Conventional radiography has been the mainstay for detection of joint damage and subsequent follow-up. Radiography can provide only indirect information on synovial inflammation, however, and the technique is insensitive to early bone damage. The development of new therapeutics for rheumatoid arthritis, such as the anti–tumor necrosis factor (TNF) α agents which are powerful and expensive drugs has created new demands on radiologists to identify patients with aggressive rheumatoid arthritis at an early stage to affect the therapeutic management of these patients. MRI and sonography can be useful tools in evaluating patients with early rheumatoid arthritis. Both imaging techniques can detect preerosive synovitis. They can also identify early bone damage before it becomes apparent on radiography. Furthermore, MRI can be used to predict future bone damage. The wrist and the metacarpophalangeal (MCP) joints are among the first areas to be affected in rheumatoid arthritis. The most symptomatic extremity, the dominant extremity, or both may be studied with MRI and sonography. Abnormalities in early rheumatoid arthritis include synovitis, tenosynovitis, bone erosions, bone marrow edema, and bursitis.