الفهرس 
ANATOMY OF JOINTSOnly 14 pages are availabe for public view
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Abstract
R
heumatoid 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.
There is increasing demand for a diagnosing method able to identify the early signs of the disease, especially with the increasing use of disease-modifying antirheumatic drugs.
MRI is an excellent imaging method that can assess both osseous and non-osseous compartments of the joint, and it have increasingly been used in early diagnosis of RA. It is very sensitive in detecting proliferative synovitis, which is the earliest pathologic feature for RA and it’s the precursor for bone and cartilage erosion.
MRI is the only imaging method that can identify bone marrow edema, which has been found to be significant indicator of joint inflammation as well as a marker of bone pathology and future bone erosions. MRI also can detect tenosynovitis, joint effusion and bone erosions.
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.
We imaged the hands and wrist joints of different aged population, and compared with the laboratory investigations and clinical examination.
The twenty-five patients included in this study (14 females, 64%, and 11 males, 36%), 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 detection 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 correlated with the 2010 ACR/EULA scoring system.
The statistical correlation of synovitis and BME with the 2010 ACR/EULA scoring system was insignificant, but the fact that the false positive value of synovitis and BME represent the presence of inflammatory finding in patients who didn’t meet the classification criteria at time of examination, indicating the higher sensitivity of MRI over the clinical scoring system.
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.