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Semin Musculoskelet Radiol 2004; 08(4): 269-285
DOI: 10.1055/s-2004-861575
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Imaging of Bone Erosion in Rheumatoid Arthritis

Ali Guermazi1 , 2 , Bachir Taouli2 , John A. Lynch2 , Charles G. Peterfy1
  • 1Synarc Inc., San Francisco, California
  • 2Department of Radiology, University of California, San Francisco, California
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Publication History

Publication Date:
10 January 2005 (online)

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ABSTRACT

Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis, with a prevalence of 1% in the United States. Recently introduced disease-modifying antirheumatic drugs have been extremely successful in preventing irreversible joint damage, particularly if initiated early. Accordingly, accurate and early diagnosis of RA has become imperative. This shift places increased demands on imaging to identify even the slightest traces of erosive joint damage and predict future structural and functional deterioration. Unfortunately, conventional radiography has been shown to be insensitive for bone erosions, particularly in early stages of the disease. Computed tomography (CT) is rarely used, but its tomographic perspective offers advantages over projectional radiography. Ultrasound (US) detects more erosions than radiography does and also can evaluate synovitis. Scintigraphy also can detect inflammation and bone turnover at sites of active erosion. It lacks spatial resolution but offers greater anatomical coverage, making whole-body assessments possible. Of all imaging modalities, however, magnetic resonance imaging (MRI) shows the greatest sensitivity for detecting and monitoring bone erosions and also can detect and follow pre-erosive features of RA, such as synovitis, bone marrow edema or osteitis, and tendinous and ligamentous abnormalities. In this article, we review the appearance of bone erosions on conventional radiography and alternative imaging modalities including MRI, CT, US, and scintigraphy. We also review alternative acquisition techniques for MRI in RA and discuss the utility of fat suppression and contrast enhancement.

KEYWORDS

MRI - CT - US - radiography - scintigraphy - bone erosion - rheumatoid arthritis

REFERENCES

  • 1 Jones G, Halbert J, Crotty M et al.. The effect of treatment on radiological progression in rheumatoid arthritis: a systematic review of randomized placebo-controlled trials.  Rheumatology (Oxford). 2003;  42 6-13
    CrossrefPubMedGoogle Scholar
  • 2 Gasson J, Gandy S J, Hutton C W et al.. Magnetic resonance imaging of rheumatoid arthritis in metacarpophalangeal joints.  Skeletal Radiol. 2000;  29 324-334
    CrossrefPubMedGoogle Scholar
  • 3 Genant H K, Jiang Y, Peterfy C et al.. Assessment of rheumatoid arthritis using a modified scoring method on digitized and original radiographs.  Arthritis Rheum. 1998;  41 1583-1590
    CrossrefPubMedGoogle Scholar
  • 4 Giovagnoni A, Valeri G, Burroni E, Amici F. Rheumatoid arthritis: follow-up and response to treatment.  Eur J Radiol. 1998;  27(Suppl 1) S25-S30
    CrossrefPubMedGoogle Scholar
  • 5 Sharp J T. Radiologic assessment as an outcome measure in rheumatoid arthritis.  Arthritis Rheum. 1989;  32 221-229
    PubMedGoogle Scholar
  • 6 Sharp J T. Scoring radiographic abnormalities in rheumatoid arthritis.  Radiol Clin North Am. 1996;  34 233-241x
    PubMedGoogle Scholar
  • 7 Sharp J T, Young D Y, Bluhm G B et al.. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis?.  Arthritis Rheum. 1985;  28 1326-1335
    CrossrefPubMedGoogle Scholar
  • 8 Sharp J T, Bluhm G B, Brook A et al.. Reproducibility of multiple-observer scoring of radiologic abnormalities in the hands and wrists of patients with rheumatoid arthritis.  Arthritis Rheum. 1985;  28 16-24
    PubMedGoogle Scholar
  • 9 Klarlund M, Ostergaard M, Gideon P et al.. Wrist and finger joint MR imaging in rheumatoid arthritis.  Acta Radiol. 1999;  40 400-409
    CrossrefPubMedGoogle Scholar
  • 10 Wakefield R J, Gibbon W W, Conaghan P G et al.. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography.  Arthritis Rheum. 2000;  43 2762-2770
    CrossrefPubMedGoogle Scholar
  • 11 Genant H K. Methods of assessing radiographic change in rheumatoid arthritis.  Am J Med. 1983;  75 35-47
    PubMedGoogle Scholar
  • 12 De Smet A A, Goin J E, Arnett G R et al.. Comparison of two detail screen-film systems using a rheumatoid erosion model.  Invest Radiol. 1983;  18 359-363
    PubMedGoogle Scholar
  • 13 van der Heijde D M. Radiographic imaging: the “gold standard” for assessment of disease progression in rheumatoid arthritis.  Rheumatology (Oxford). 2000;  39(Suppl 1) 9-16
    Google Scholar
  • 14 Buckland-Wright J C. Microfocal radiographic examination of erosions in the wrist and hand of patients with rheumatoid arthritis.  Ann Rheum Dis. 1984;  43 160-171
    PubMedGoogle Scholar
  • 15 McGonagle D, Conaghan P G, Wakefield R, Emery P. Imaging the joints in early rheumatoid arthritis.  Best Pract Res Clin Rheumatol. 2001;  15 91-104
    CrossrefPubMedGoogle Scholar
  • 16 Gilkeson G, Polisson R, Sinclair H et al.. Early detection of carpal erosions in patients with rheumatoid arthritis: a pilot study of magnetic resonance imaging.  J Rheumatol. 1988;  15 1361-1366
    PubMedGoogle Scholar
  • 17 Buckland-Wright J C, Clarke G S, Walker S R. Erosion number and area progression in the wrists and hands of rheumatoid patients: a quantitative microfocal radiographic study.  Ann Rheum Dis. 1989;  48 25-29
    PubMedGoogle Scholar
  • 18 Rau R, Wassenberg S, Herborn G et al.. Identification of radiologic healing phenomena in patients with rheumatoid arthritis.  J Rheumatol. 2001;  28 2608-2615
    PubMedGoogle Scholar
  • 19 Sharp J T, Van Der Heijde D, Boers M et al.. Repair of erosions in rheumatoid arthritis does occur. Results from 2 studies by the OMERACT Subcommittee on Healing of Erosions.  J Rheumatol. 2003;  30 1102-1107
    PubMedGoogle Scholar
  • 20 Van Der Heijde D, Sharp J T, Rau R, Strand V. OMERACT Workshop: repair of structural damage in rheumatoid arthritis.  J Rheumatol. 2003;  30 1108-1109
    PubMedGoogle Scholar
  • 21 Brower A C. Use of the radiograph to measure the course of rheumatoid arthritis. The gold standard versus fool's gold.  Arthritis Rheum. 1990;  33 316-324
    CrossrefPubMedGoogle Scholar
  • 22 Brower A C. Radiographic assessment of disease progression in rheumatoid arthritis.  Rheum Dis Clin North Am. 1991;  17 471-485
    PubMedGoogle Scholar
  • 23 Devauchelle Pensec V, Saraux A, Berthelot J M et al.. Ability of hand radiographs to predict a further diagnosis of rheumatoid arthritis in patients with early arthritis.  J Rheumatol. 2001;  28 2603-2607
    PubMedGoogle Scholar
  • 24 Ostergaard M, Gideon P, Sorensen K et al.. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist.  Scand J Rheumatol. 1995;  24 212-218
    CrossrefPubMedGoogle Scholar
  • 25 Backhaus M, Burmester G R, Sandrock D et al.. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints.  Ann Rheum Dis. 2002;  61 895-904
    CrossrefPubMedGoogle Scholar
  • 26 McGonagle D, Conaghan P G, O'Connor P et al.. The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study.  Arthritis Rheum. 1999;  42 1706-1711
    CrossrefPubMedGoogle Scholar
  • 27 Conaghan P G, Quinn M A, O'Connor P et al.. Can very high-dose anti-tumor necrosis factor blockade at onset of rheumatoid arthritis produce long-term remission?.  Arthritis Rheum. 2002;  46 1971-1972 , author reply 1973
    CrossrefPubMedGoogle Scholar
  • 28 Lassere M N, Bird P. Measurement of rheumatoid arthritis disease activity and damage using magnetic resonance imaging. Truth and discrimination: does MRI make the grade?.  J Rheumatol. 2001;  28 1151-1157
    PubMedGoogle Scholar
  • 29 McQueen F M, Benton N, Crabbe J et al.. 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;  60 859-868
    PubMedGoogle Scholar
  • 30 Karim Z, Wakefield R J, Conaghan P G et al.. The impact of ultrasonography on diagnosis and management of patients with musculoskeletal conditions.  Arthritis Rheum. 2001;  44 2932-2933
    CrossrefPubMedGoogle Scholar
  • 31 Conaghan P G, McGonagle D, Wakefield R, Emery P. New approaches to imaging of early rheumatoid arthritis.  Clin Exp Rheumatol. 1999;  17(6 Suppl 18) S37-S42
    PubMedGoogle Scholar
  • 32 Backhaus M, Burmester G R, Gerber T et al.. Guidelines for musculoskeletal ultrasound in rheumatology.  Ann Rheum Dis. 2001;  60 641-649
    CrossrefPubMedGoogle Scholar
  • 33 Alarcon G S, Lopez-Ben R, Moreland L W. High-resolution ultrasound for the study of target joints in rheumatoid arthritis.  Arthritis Rheum. 2002;  46 1969-1970 , author reply 1970-1971
    CrossrefPubMedGoogle Scholar
  • 34 Weidekamm C, Koller M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis.  Arthritis Rheum. 2003;  48 325-333
    CrossrefPubMedGoogle Scholar
  • 35 Grassi W, Filippucci E, Farina A et al.. Ultrasonography in the evaluation of bone erosions.  Ann Rheum Dis. 2001;  60 98-103
    CrossrefPubMedGoogle Scholar
  • 36 Backhaus M, Kamradt T, Sandrock D et al.. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging.  Arthritis Rheum. 1999;  42 1232-1245
    CrossrefPubMedGoogle Scholar
  • 37 Roben P, Barkmann R, Ullrich S et al.. Assessment of phalangeal bone loss in patients with rheumatoid arthritis by quantitative ultrasound.  Ann Rheum Dis. 2001;  60 670-677
    CrossrefPubMedGoogle Scholar
  • 38 Mc Gonagle D, Gibbon W, O'Connor P et al.. A preliminary study of ultrasound aspiration of bone erosion in early rheumatoid arthritis.  Rheumatology (Oxford). 1999;  38 329-331
    CrossrefPubMedGoogle Scholar
  • 39 Ostergaard M, Szkudlarek M. Imaging in rheumatoid arthritis-why MRI and ultrasonography can no longer be ignored.  Scand J Rheumatol. 2003;  32 63-73
    CrossrefPubMedGoogle Scholar
  • 40 McQueen F, Lassere M, Edmonds J et al.. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Summary of OMERACT 6 MR Imaging Module.  J Rheumatol. 2003;  30 1387-1392
    PubMedGoogle Scholar
  • 41 Voog U, Alstergren P, Eliasson S et al.. Inflammatory mediators and radiographic changes in temporomandibular joints of patients with rheumatoid arthritis.  Acta Odontol Scand. 2003;  61 57-64
    PubMedGoogle Scholar
  • 42 Alasaarela E, Suramo I, Tervonen O et al.. Evaluation of humeral head erosions in rheumatoid arthritis: a comparison of ultrasonography, magnetic resonance imaging, computed tomography and plain radiography.  Br J Rheumatol. 1998;  37 1152-1156
    CrossrefPubMedGoogle Scholar
  • 43 Klarlund M, Ostergaard M, Jensen K E et al.. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group.  Ann Rheum Dis. 2000;  59 521-528
    CrossrefPubMedGoogle Scholar
  • 44 McQueen F M, Stewart N, Crabbe J et al.. 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;  57 350-356
    CrossrefPubMedGoogle Scholar
  • 45 Peterfy C G. New developments in imaging in rheumatoid arthritis.  Curr Opin Rheumatol. 2003;  15 288-295
    CrossrefPubMedGoogle Scholar
  • 46 Rominger M B, Bernreuter W K, Kenney P J et al.. MR imaging of the hands in early rheumatoid arthritis: preliminary results.  Radiographics. 1993;  13 37-46
    PubMedGoogle Scholar
  • 47 Foley-Nolan D, Stack J P, Ryan M et al.. Magnetic resonance imaging in the assessment of rheumatoid arthritis-a comparison with plain film radiographs.  Br J Rheumatol. 1991;  30 101-106
    CrossrefPubMedGoogle Scholar
  • 48 Ostendorf B, Peters R, Dann P et al.. Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis.  Arthritis Rheum. 2001;  44 2492-2502
    CrossrefPubMedGoogle Scholar
  • 49 Ostergaard M, Hansen M, Stoltenberg M et al.. 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;  42 918-929
    CrossrefPubMedGoogle Scholar
  • 50 Cimmino M A, Bountis C, Silvestri E et al.. An appraisal of magnetic resonance imaging of the wrist in rheumatoid arthritis.  Semin Arthritis Rheum. 2000;  30 180-195
    CrossrefPubMedGoogle Scholar
  • 51 McQueen F M, Stewart N, Crabbe J et al.. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement.  Ann Rheum Dis. 1999;  58 156-163
    CrossrefPubMedGoogle Scholar
  • 52 Peterfy C G. Magnetic resonance imaging of rheumatoid arthritis: the evolution of clinical applications through clinical trials.  Semin Arthritis Rheum. 2001;  30 375-396
    CrossrefPubMedGoogle Scholar
  • 53 Peterfy C G. Magnetic resonance imaging of the wrist in rheumatoid arthritis.  Semin Musculoskelet Radiol. 2001;  5 275-288
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Stewart N R, McQueen F M, Crabbe J P. Magnetic resonance imaging of the wrist in early rheumatoid arthritis: a pictorial essay.  Australas Radiol. 2001;  45 268-273
    CrossrefPubMedGoogle Scholar
  • 55 Peterfy C G. Magnetic resonance imaging in rheumatoid arthritis: current status and future directions.  J Rheumatol. 2001;  28 1134-1142
    PubMedGoogle Scholar
  • 56 Savnik A, Malmskov H, Thomsen H S et al.. MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions.  Eur Radiol. 2002;  12 1203-1210
    CrossrefPubMedGoogle Scholar
  • 57 Huang J, Stewart N, Crabbe J et al.. A 1-year follow-up study of dynamic magnetic resonance imaging in early rheumatoid arthritis reveals synovitis to be increased in shared epitope-positive patients and predictive of erosions at 1 year.  Rheumatology (Oxford). 2000;  39 407-416
    CrossrefPubMedGoogle Scholar
  • 58 Lee D M, Weinblatt M E. Rheumatoid arthritis.  Lancet. 2001;  358 903-911
    CrossrefPubMedGoogle Scholar
  • 59 Kirwan J R. The relationship between synovitis and erosions in rheumatoid arthritis.  Br J Rheumatol. 1997;  36 225-228
    CrossrefPubMedGoogle Scholar
  • 60 Ostergaard M, Klarlund M, Lassere M et al.. Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints-an international multicenter study.  J Rheumatol. 2001;  28 1143-1150
    PubMedGoogle Scholar
  • 61 Lassere M, McQueen F, Ostergaard M et al.. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI score.  J Rheumatol. 2003;  30 1366-1375
    PubMedGoogle Scholar
  • 62 Peterfy C, Edmonds J, Lassere M et al.. OMERACT Rheumatoid Arthritis MRI Studies Module.  J Rheumatol. 2003;  30 1364-1365
    PubMedGoogle Scholar
  • 63 Bird P, Ejbjerg B, McQueen F et al.. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 5: an international multicenter reliability study using computerized MRI erosion volume measurements.  J Rheumatol. 2003;  30 1380-1384
    PubMedGoogle Scholar
  • 64 Ostrowitzki S, Redei J, Lynch J A et al.. Use of multispectral MRI analysis to quantify erosive changes in the hands of patients with rheumatoid arthritis: a short-term and a long-term longitudinal study.  Arthritis Rheum. 2004;  50 716-724
    CrossrefPubMedGoogle Scholar
  • 65 Tonolli-Serabian I, Poet J L, Dufour M et al.. Magnetic resonance imaging of the wrist in rheumatoid arthritis: comparison with other inflammatory joint diseases and control subjects.  Clin Rheumatol. 1996;  15 137-142
    CrossrefPubMedGoogle Scholar
  • 66 Savnik A, Malmskov H, Thomsen H S et al.. MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T).  Eur Radiol. 2001;  11 1030-1038
    CrossrefPubMedGoogle Scholar
  • 67 McQueen F M. Magnetic resonance imaging in early inflammatory arthritis: what is its role?.  Rheumatology (Oxford). 2000;  39 700-706
    CrossrefPubMedGoogle Scholar
  • 68 Lindegaard H, Vallo J, Horslev-Petersen K et al.. Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset.  Ann Rheum Dis. 2001;  60 770-776
    CrossrefPubMedGoogle Scholar
  • 69 Weissman B N. Imaging techniques in rheumatoid arthritis.  J Rheumatol Suppl. 1994;  42 14-19
    PubMedGoogle Scholar
  • 70 Mottonen T T, Hannonen P, Toivanen J et al.. Value of joint scintigraphy in the prediction of erosiveness in early rheumatoid arthritis.  Ann Rheum Dis. 1988;  47 183-189
    PubMedGoogle Scholar

Ali GuermaziM.D. 

Synarc, Inc., 575 Market Street, 17th Floor

San Francisco, CA, 94105

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