Abstract
Conventional radiographs of the hands and feet have traditionally been used in the diagnosis, management and monitoring of patients with rheumatoid arthritis (RA). However, they are not sensitive enough to detect changes early in the disease process. Erosions may only be visible up to two years after the onset of disease, and soft tissue involvement may not be detected at all. Early diagnosis can also be made challenging as markers such as erythrocyte sedimentation rate and C-reactive protein may be normal in up to 20% – 25% of cases. The latest classification criteria (American College of Rheumatology/European League Against Rheumatism [ACR/EULAR] Rheumatoid Arthritis Classification criteria 2010), often used to diagnose RA, incorporate the role of ultrasound and magnetic resonance imaging detection of synovitis, enabling earlier diagnosis and correct classification of patients. This article looks at the role of the various imaging modalities used in the diagnosis and management of RA.
Highlights
Rheumatoid arthritis (RA) is a chronic auto-immune disease which is characterised by persistent inflammation and joint damage
With the ground-breaking advances made in the management of RA, optimal treatment mandates treating to a target of at least low disease activity
Conventional radiography has been the gold standard for imaging in RA for a long time, but the sensitivity for structural damage in the diagnosis of RA is low and disease activity cannot be assessed
Summary
Rheumatoid arthritis (RA) is a chronic auto-immune disease which is characterised by persistent inflammation and joint damage. These include soft tissue, cartilage and bones This imaging method is highly sensitive and can detect early erosions up to three years before they may be seen with conventional radiography (Figure 5 a and b). Note: this is the same patient in Figure 5 showing multiple areas of enhancement of the bones corresponding to the regions of bone oedema seen, and synovial enhancement in the second metacarpophalangeal joint This supports active disease in this hand. Various groups in different studies have shown that BME is the strongest of conventional and imaging biomarkers for the prediction of erosive progression of RA.[5]
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