Abstract
BackgroundTo evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), using a novel 16-channel high-resolution hand coil.MethodsSeventeen patients with active PsA, 20 patients with active RA, and 16 healthy controls (HC) underwent high-resolution 3 T MRI using the dedicated 16-channel hand coil. Images were analyzed by three independent readers for the degree of inflammatory changes, thickness of flexor tendon pulleys, and comparison to the outcome measures for RA clinical trials (OMERACT) PsA MRI score (PsAMRIS) and to its sub-scores. For correlation analyses, Spearman rho correlation was calculated.ResultsFlexor tendon pulleys were thicker in PsA than in RA patients (mean difference 0.16 mm, p < 0.001) and HC (mean difference 0.2 mm, p < 0.001) and showed a higher degree of associated inflammatory changes (mean difference from RA 4.7, p = 0.048; mean difference from HC 14.65, p < 0.001). Additionally, there was a strong correlation of accessory pulley inflammation and PsAMRIS and its acute-inflammatory sub-scores, flexor tenosynovitis, synovitis, and periarticular inflammation (for the second digit synovitis ρ = 0.72, flexor tenosynovitis ρ = 0.7, overall PsAMRIS ρ = 0.72, p < 0.01). Similar robust correlations were evident in digits 3–5. Weaker correlations were evident in RA (synovitis ρ = 0.49, flexor tenosynovitis ρ = 0.49, periarticular inflammation ρ = 0.4).ConclusionThe assessment of MRI changes of flexor tendon pulleys is potentially beneficial for disease detection in PsA, as well as for its distinction from RA and HC.Trial registration2014123117, December 2014.
Highlights
To evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), using a novel 16-channel highresolution hand coil
Inter- and intra-rater reliability for PsA MRI score (PsAMRIS) at MCP joint level in PsA and RA patients Descriptive analysis of inflammation sub-scores according to PsAMRIS are illustrated in Table 1 for PsA and in Table 2 for RA patients
After Bonferroni correction, p values < 0.0167 were considered significant and are given in bold type In RA patients, we found a significant, but weaker, correlation between pulley inflammation and overall PsAMRIS as well as inflammatory PsAMRIS sub-scores as compared to PsA
Summary
To evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), using a novel 16-channel highresolution hand coil. PsA and RA differ in their pathophysiology: RA is considered to be a synovial disease that exhibits secondary spread to the adjacent bone; PsA on the other hand characteristically affects entheses, such as tendon and ligament insertion sites. These can be classified as fibrous and fibrocartilaginous and belong to the so-called synovio-entheseal complex [6,7,8,9,10]. Tendons build so-called functional entheses with associated ligamentous structures, such as flexor tendon pulleys [11]. Recent studies have shown that inflammation and thickening of flexor tendon pulleys are potentially due to mechanical stress (“deep Koebner response”) and may lead to the initial development of flexor tenosynovitis and dactylitis, that are major features of PsA [13,14,15]
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