Abstract
BackgroundBecause of overlapping phenotypical presentations, the diagnostic differentiation of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) remains challenging. Thus, this study aimed to examine the diagnostic value of distinct imaging features obtained by high-resolution 3-T MRI for the diagnostic differentiation.Materials and methodsSeventeen patients with PsA and 28 patients with RA were imaged at high resolution using 3-T MRI scanners and a dedicated 16-channel hand coil. All images were analyzed according to the outcome measures in rheumatology clinical trials’ (OMERACT) RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score) and PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Score) for the presence and intensity of synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, bone proliferation, and joint space narrowing. Next, odds ratios (OR) were calculated to determine the strength of the associations between these imaging features, demographic characteristics, and the outcome RA vs. PsA.ResultsPsA could be differentiated from RA by extracapsular inflammatory changes (PsAMRIS sub-score “periarticular inflammation”), with low odds for the presence of RA (OR of 0.06, p < 0.01) at all metacarpophalangeal (MCP) joints. A prediction model informed by the items that were strongest associated with the presence of RA or PsA demonstrated excellent differentiating capability with an area under the curve of 98.1%.ConclusionHigh-resolution imaging is beneficial for the identification of relevant imaging features that may assist the clinical differentiation of inflammatory conditions of the hand. At the MCP level, extracapsular inflammatory changes were strongly associated with PsA and may consequently allow the imaging differentiation of PsA and RA.
Highlights
Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic inflammatory conditions that cause progressive destruction of cartilage and bone [1]
Odds ratios for gender, age, and RAMRIS and PsAMRIS sub-scores for the outcome rheumatoid arthritis (RA) vs. PsA
At the MCP level, extracapsular inflammation was strongly associated with PsA, while flexor tenosynovitis was associated with RA
Summary
Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic inflammatory conditions that cause progressive destruction of cartilage and bone [1] Even though these entities share pathophysiological features and phenotypical manifestations, several studies hypothesized that RA and PsA differ in their pattern of joint involvement [2]. In MRI, field strength needs to be invested adequately to achieve proper image resolution, signal-to-noise ratio, and contrast to best differentiate the disease entities, in particular when imaging delicate structures such as the small finger joints, the entheses, and the nails for subtle changes. This may be hampered when field strength is low At the MCP level, extracapsular inflammatory changes were strongly associated with PsA and may allow the imaging differentiation of PsA and RA
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