Magnetic resonance imaging of the wrist in defining remission of rheumatoid arthritis.

Abstract

OBJECTIVE:

To assess the efficacy of magnetic resonance imaging (MRI) in objectively defining a state of remission in rheumatoid arthritis (RA) after treatment.

METHODS:

Ten patients with RA involving the wrist were evaluated before treatment with methotrexate and hydroxychloroquine, and then mean 14 mo later with a followup evaluation. Clinical variables, laboratory measurements, and MRI using various techniques (T1 weighted image, T2 weighted image, fat suppression T2 weighted image, postcontrast T1 weighted image, postcontrast dynamic image, postcontrast 3 dimensional image) were observed. Remission was defined by ACR criteria. MRI changes were observed using 3 variables: extent of synovial proliferation; extent of bone marrow edema; and development of new erosion. In 6 of 10 patients, synovial signal intensity time curve changes at 30 s (E30 ratio) were determined for quantitative assessment of synovitis.

RESULTS:

Four patients achieved remission and 6 did not. All patients in remission showed decrease in extent of synovial proliferation and bone marrow edema with no newly developed erosion after treatment, compared to baseline. Five of 6 patients in nonremission showed newly developed erosions with variable changes in extent of synovial proliferation and bone marrow edema. E30 ratio was determined in 3 patients in the remission group and 3 in the nonremission group, with 48% reduction in the former compared to 9% reduction in the latter.

CONCLUSION:

MRI is feasible for objectively defining remission and assessing the therapeutic effect of antirheumatic drugs; utility of MRI measures in clinical remission criteria remains to be verified.

• Authors: J Lee, S K Lee, J S Suh, M Yoon, J H Song, C H Lee
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 24 Issue 7 Pg. 1303-8 (Jul 1997) ISSN: 0315-162X [Print] Canada
• PMID: 9228129 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antirheumatic Agents
• Contrast Media
• Organometallic Compounds
• Hydroxychloroquine
• Pentetic Acid
• Gadolinium DTPA
• Methotrexate

Topics

• Adult
• Antirheumatic Agents (administration & dosage)
• Arthritis, Rheumatoid (diagnosis, drug therapy, pathology)
• Contrast Media
• Evaluation Studies as Topic
• Female
• Gadolinium DTPA
• Humans
• Hydroxychloroquine (administration & dosage)
• Magnetic Resonance Imaging
• Male
• Methotrexate (administration & dosage)
• Middle Aged
• Organometallic Compounds
• Pentetic Acid (analogs & derivatives)
• Remission Induction
• Remission, Spontaneous
• Wrist (pathology)