• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. May 2004; 63(5): 555–561.
PMCID: PMC1755000

MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years

Abstract

Objectives: To determine whether magnetic resonance (MR) scans of the dominant wrist of patients with early rheumatoid arthritis (RA) can be used to predict functional outcome at 6 years' follow up.

Methods: Dominant wrist MR scans were obtained in 42 patients with criteria for RA at first presentation. Patients were followed up prospectively for 6 years, and further scans obtained at 1 year (42 patients) and 6 years (31 patients). Two radiologists scored scans for synovitis, tendonitis, bone oedema, and erosions. The Stanford Health Assessment Questionnaire (HAQ) score, indicating functional outcome, and standard measures of disease activity were assessed at 0, 1, 2, and 6 years. The physical function component of the SF-36 score (PF-SF36) was also used as a functional outcome measure at 6 years.

Results: Baseline MR parameters, including bone oedema score and the total baseline MR score, were predictive of the PF-SF36 at 6 years (R2 = 0.22, p = 0.005 and R2 = 0.16, p = 0.02, respectively). The PF-SF36 score correlated strongly with the HAQ score at 6 years (rs = –0.725, p<0.0001); none of the baseline MR parameters predicted the 6 year HAQ score. The total MR score obtained at 1 year was predictive of the 6 year HAQ (R2 = 0.04, p = 0.01). Standard clinical and radiographic measures at baseline were not predictive of the 6 year PF-SF36, but when combined in a model with baseline MR oedema score, prediction increased from 0.09 to 0.23, or 23% of the 6 year variance.

Conclusion: MR imaging of the wrist in patients with early RA can help to predict function at 6 years and could be used to plan aggressive management at an earlier stage.

Full Text

The Full Text of this article is available as a PDF (354K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Möttönen TT. Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis. Ann Rheum Dis. 1988 Aug;47(8):648–653. [PMC free article] [PubMed]
  • Fuchs HA, Kaye JJ, Callahan LF, Nance EP, Pincus T. Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease. J Rheumatol. 1989 May;16(5):585–591. [PubMed]
  • Wiles NJ, Dunn G, Barrett EM, Harrison BJ, Silman AJ, Symmons DP. One year followup variables predict disability 5 years after presentation with inflammatory polyarthritis with greater accuracy than at baseline. J Rheumatol. 2000 Oct;27(10):2360–2366. [PubMed]
  • den Broeder AA, Joosten LAB, Saxne T, Heinegård D, Fenner H, Miltenburg AMM, Frasa WLH, van Tits LJ, Buurman WA, van Riel PLCM, et al. Long term anti-tumour necrosis factor alpha monotherapy in rheumatoid arthritis: effect on radiological course and prognostic value of markers of cartilage turnover and endothelial activation. Ann Rheum Dis. 2002 Apr;61(4):311–318. [PMC free article] [PubMed]
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. [PubMed]
  • van Zeben D, Breedveld FC. Prognostic factors in rheumatoid arthritis. J Rheumatol Suppl. 1996 Mar;44:31–33. [PubMed]
  • Feigenbaum SL, Masi AT, Kaplan SB. Prognosis in rheumatoid arthritis. A longitudinal study of newly diagnosed younger adult patients. Am J Med. 1979 Mar;66(3):377–384. [PubMed]
  • Combe B, Eliaou JF, Daurès JP, Meyer O, Clot J, Sany J. Prognostic factors in rheumatoid arthritis. Comparative study of two subsets of patients according to severity of articular damage. Br J Rheumatol. 1995 Jun;34(6):529–534. [PubMed]
  • van Leeuwen MA, van Rijswijk MH, van der Heijde DM, Te Meerman GJ, van Riel PL, Houtman PM, van De Putte LB, Limburg PC. The acute-phase response in relation to radiographic progression in early rheumatoid arthritis: a prospective study during the first three years of the disease. Br J Rheumatol. 1993 Jun;32 (Suppl 3):9–13. [PubMed]
  • Welsing PM, van Gestel AM, Swinkels HL, Kiemeney LA, van Riel PL. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001 Sep;44(9):2009–2017. [PubMed]
  • McQueen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PL, McLean L. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis. 1998 Jun;57(6):350–356. [PMC free article] [PubMed]
  • McQueen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PL, McLean L. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis. 1999 Mar;58(3):156–163. [PMC free article] [PubMed]
  • McQueen FM, Benton N, Crabbe J, Robinson E, Yeoman S, McLean L, Stewart N. What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using x rays and magnetic resonance imaging over the first two years of disease. Ann Rheum Dis. 2001 Sep;60(9):859–868. [PMC free article] [PubMed]
  • McQueen Fiona M, Benton Nick, Perry David, Crabbe Jeff, Robinson Elizabeth, Yeoman Sue, McLean Lachy, Stewart Neal. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum. 2003 Jul;48(7):1814–1827. [PubMed]
  • Li G, Haq W, Xiang L, Lou BS, Hughes R, De Leon IA, Davis P, Gillespie TJ, Romanowski M, Zhu X, et al. Modifications of the 4,4'-residues and SAR studies of Biphalin, a highly potent opioid receptor active peptide. Bioorg Med Chem Lett. 1998 Mar 3;8(5):555–560. [PubMed]
  • Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed]
  • Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. [PubMed]
  • van der Heijde DM, van 't Hof MA, van Riel PL, Theunisse LA, Lubberts EW, van Leeuwen MA, van Rijswijk MH, van de Putte LB. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990 Nov;49(11):916–920. [PMC free article] [PubMed]
  • Buchbinder R, Bombardier C, Yeung M, Tugwell P. Which outcome measures should be used in rheumatoid arthritis clinical trials? Clinical and quality-of-life measures' responsiveness to treatment in a randomized controlled trial. Arthritis Rheum. 1995 Nov;38(11):1568–1580. [PubMed]
  • McHorney CA, Ware JE, Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994 Jan;32(1):40–66. [PubMed]
  • Talamo J, Frater A, Gallivan S, Young A. Use of the short form 36 (SF36) for health status measurement in rheumatoid arthritis. Br J Rheumatol. 1997 Apr;36(4):463–469. [PubMed]
  • Scott DL, Pugner K, Kaarela K, Doyle DV, Woolf A, Holmes J, Hieke K. The links between joint damage and disability in rheumatoid arthritis. Rheumatology (Oxford) 2000 Feb;39(2):122–132. [PubMed]
  • Drossaers-Bakker KW, de Buck M, van Zeben D, Zwinderman AH, Breedveld FC, Hazes JM. Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheum. 1999 Sep;42(9):1854–1860. [PubMed]
  • Gilkeson G, Polisson R, Sinclair H, Vogler J, Rice J, Caldwell D, Spritzer C, Martinez S. Early detection of carpal erosions in patients with rheumatoid arthritis: a pilot study of magnetic resonance imaging. J Rheumatol. 1988 Sep;15(9):1361–1366. [PubMed]
  • Foley-Nolan D, Stack JP, Ryan M, Redmond U, Barry C, Ennis J, Coughlan RJ. Magnetic resonance imaging in the assessment of rheumatoid arthritis--a comparison with plain film radiographs. Br J Rheumatol. 1991 Apr;30(2):101–106. [PubMed]
  • Boutry Nathalie, Lardé Anne, Lapègue Franck, Solau-Gervais Elizabeth, Flipo René-Marc, Cotten Anne. Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. J Rheumatol. 2003 Apr;30(4):671–679. [PubMed]
  • Ostergaard M, Hansen M, Stoltenberg M, Gideon P, Klarlund M, Jensen KE, Lorenzen I. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum. 1999 May;42(5):918–929. [PubMed]

Figures and Tables

Figure 1
Progression of MR, clinical, and functional parameters over 6 years. Solid lines indicate median scores at 0, 1, and 6 years for MR parameters and 0, 1, 2, and 6 years for DAS and HAQ. Dotted lines indicate interquartile ranges.
Figure 2
Sequential MR scans of the dominant carpus over 6 years in a 44 year old patient who was non-compliant with disease modifying treatment. This patient has congenital fusion of the triquetrum and lunate. (A) The baseline T1 weighted coronal scan shows ...

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...