The Role of Magnetic Resonance Imaging in Diagnosis and Prognosis of Rheumatoid Arthritis

Abstract Background: Rheumatoid arthritis (RA) is one of the most common forms of arthritis. A progressive joint damage occurs early in the disease course even before being detected in conventional imaging, and eventually leads to irreversible joint deformity and severe functional impairment. Routinely, clinical assessment and laboratory investigations as well as conventional radiology are used for diagnosis of RA, however; they are not fair enough to establish early diagnosis and can't provide information about the disease activity. Estimating the disease activity at onset is fundamental to identify the prognosis of RA. Aim of Study: The aim of this study was to demonstrate the importance of MRI in detecting early signs of arthritis helping in early diagnosis of rheumatoid arthritis, and its ability to assess the degree of inflammatory activity as a prognostic parameter for the development of subsequent bone destruction. Patients and Methods: The twenty-five patients included in this study (14 females, 56%, and 11 males, 44%), were diagnosed with rheumatoid arthritis according to the 2010 ACR/EULA classification criteria. The clinically dominant wrist and hand joints were examined by MRI study for detec-tion of pathological signs of RA that include synovitis, BME, and erosions. Twenty (20) patients (80%) were found to have synovial thickening. Of which, 12 wrist joints (60%) were active, among them 5 joints (25%) had mild activity, 4 (20%) had moderate activity and 3 wrist joints had severe activity (15%). 17 patients had bone marrow edema (68%), more frequently at the radius and the lunate. Erosions was seen in 8 joints (32 %). The total positive MRI inflammatory findings, as well as each one of them alone, were compared and corre-lated with the 2010 ACR/EULA scoring system. Results: We found significant correlation and agreement between the total MRI positive findings and the 2010 ACR/EULAR criteria used for diagnosing RA, and MRI was more sensitive in detecting synovitis and BME in patients who didn't meet the criteria. Conclusion: The high sensitivity of MRI in detecting inflammatory signs, and the significant correlation with clinical and laboratory findings, indicates the potential importance of MRI study in diagnosing RA early in its course, and the assessment of disease activity that helps in prediction of joint destruction.