Wouter Nieuwenhuis MD, Presenter: Nothing to Disclose

Annemarie Krabben, Abstract Co-Author: Employee, Johnson & Johnson

Wouter Stomp MD, Abstract Co-Author: Speaker, General Electric Company

Johan L. Bloem MD, PhD, Abstract Co-Author: Nothing to Disclose

Tom WJ Huizinga, Abstract Co-Author: Nothing to Disclose

Annette Van Der Helm-Van Mil, Abstract Co-Author: Nothing to Disclose

Monique Reijnierse MD, Abstract Co-Author: Nothing to Disclose

This study aimed to identify the frequency of MRI-detected tenosynovitis at the metacarpophalangeal (MCP) and wrist joints in early arthritis, the diagnostic value for RA and the association with severity features within RA.

178 early arthritis patients underwent unilateral 1.5T extremity-MRI at baseline. MRI-scans were made and scored using the RAMRIS-protocol. Tenosynovitis was scored at the wrist and MCP joints by two readers using the method as described by Haavardsholm et al. During the first year 69 patients fulfilled the 2010-classification criteria for RA; patients with and without RA were compared. Within RA-patients comparisons were made for anti-citrullinated-peptide-antibody (ACPA)-positivity and for radiographic progression (increase in Sharp van der Heijde score) during the first year.

65% of the 178 early arthritis patients had MRI-detected tenosynovitis at any of the studied locations. The flexor tendon at MCP-3 and the tendon of the extensor carpi ulnaris were most frequently affected (22% and 34%). Furthermore, tenosynovitis was more often present in RA than non-RA patients (75% versus 59% p 0.023). More commonly affected locations in RA than in non-RA were the tendons of the flexors at MCP-5 (odds ratio (OR) 2.8 95% CI 1.2-7.0), the extensors at MCP-2 (OR 9.1 95% CI 1.9-42.8) and MCP-4 (OR 14.2 95% CI 1.7-115.9) and extensor compartment I at the wrist 4.0 (95% CI 1.4-11.1). The specificity for these locations ranged 92-99% and the positive predictive value between 61-89%. The associations between tenosynovitis at these locations and RA were independent of the presence of local synovitis. Within RA-patients, the tenosynovitis scores were not associated with the presence of ACPA or radiographic progression during the first year.

MRI-detected tenosynovitis is common in early arthritis and is more common in RA patients than in early arthritis patients with other diagnoses. Locations with a high specificity for RA are the tendons of the flexor at MCP-5, the extensor at MCP-2 and MCP-4 and the first extensor compartment of the wrist.

MRI is a sensitive method to detect tenosynovitis. However, the prevalence of MRI-detected tenosynovitis and its diagnostic and prognostic value in early arthritis patients are unclear.

Nieuwenhuis, W, Krabben, A, Stomp, W, Bloem, J, Huizinga, T, Van Der Helm-Van Mil, A, Reijnierse, M, Evaluating MRI-detected Tenosynovitis of the Hand and Wrist in Early Arthritis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013388.html