Ultrasound Versus Magnetic Resonance Imaging for the Detection of Early Rheumatoid Arthritis in A Sub-Himalayan Region of North India: A Cross-sectional Study

Abstract

Introduction: Rheumatoid arthritis (RA) is a disability disease with predominant involvement of hands and feet. It is highly important to detect early findings of the disease so that treatment can be started as early as possible. The high cost, poor accessibility and long waiting time for Magnetic Resonanace Imaging (MRI) as compared to Ultrasound (USG) results in delayed pick up of early RA findings. Aim: To compare the radiological parameters of wrist and hand by USG and MRI in clinically diagnosed patients of early RA. Materials and methods: A cross-sectional study was conducted from January 2020 to December 2020 in the Department of Radiology, Indira Gandhi Medical College and Hospital, Shimla. A total of 25 diagnosed patients of early RA were enrolled in the study. USG and MRI were used to evaluate distal Distal Radioulnar (RU), Radiocarpal (RC), Ulnocarpal (UC), Metacarpo phalangeal (MCP) and other hand joints with clinical symptoms. The following parameters were assessed on both MRI and USG: Joint space, Joint effusion, Synovitis, Tenosynovitis, Bone erosions. Bone marrow oedema was assessed only on MRI. The categorical variables of the two groups were compared using the chi-square test. Results: The mean age of the study group was 44.96±11.58 years. There were 18 female and 7 male patients with preponderance of female patients. MRI was better than USG in picking up findings of joint space narrowing, synovial thickening, synovial vascularity and bone erosions with p-value of <0.001, which was statistically significant. For Tenosynovitis, USG and MRI were equally good with p-value of <0.001 which was statistically significant. Joint effusion was diagnosed in more number of joints 26 (6.5%) on USG as compared to 15 (3.5%) on MRI, however, the p-value was 0.078 suggesting that it was statistically insignificant. Bone marrow oedema was detected only on MRI. Conclusion: USG can be used to detect changes of early Rheumatoid Arthritis especially joint effusion and tenosynovitis when MRI is contraindicated/not available/waiting period for MRI is too long.