Differential Diagnosis of Rheumatoid and Psoriatic Arthritis at an Early Stage in the Small Hand and Foot Joints using Magnetic Resonance Imaging

V. Jevtic; G. Lingg

doi:10.1055/s-0032-1301929

Aktuelle Rheumatologie, Table of Contents

Aktuelle Rheumatologie 2012; 37(02): 105-112
DOI: 10.1055/s-0032-1301929

Review

Differential Diagnosis of Rheumatoid and Psoriatic Arthritis at an Early Stage in the Small Hand and Foot Joints using Magnetic Resonance Imaging

Differenzialdiagnose zwischen Rheumatoider und Psoriasis-Arthritis im Frühstadium an den kleinen Gelenken der Hände und Vorfüsse mittels MRT

V. Jevtic

¹Department of Radiology, Faculty for Health Sciences, University of Ljubljana, Ljubljana, Slovenia

,

G. Lingg

²Private, Bad Kreuznach, Germany, formerly Zentrales Röntgeninstitut des Sana-Rheuma-Zentrums Mainz Bad Kreuznach, Germany

› Author Affiliations

Abstract

The 2 major and clinically most important primary inflammatory rheumatic diseases which affect small hand and feet joints are rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The most important initial histopathological feature of RA is synovitis followed by chronic proliferative granulomatous pannus-tissue, which is associated with cartilage and bone destruction. Early inflammatory changes in RA also develop synchronously within the subchondral bone marrow. Enthesitis is the hallmark of SNSA, and is often seen as one of the first radiological manifestations of the diseases. As a rule inflammation within the synovial joints, histologically similar to RA, is not so pronounced. Consequently destructive changes within the synovial joints are much less with the exception of PsA in which pronounced bone destruction may develop (arthritis mutilans). Considerable overlapping in clinical and morphological manifestation of RA and PsA may be present. For evaluation of hand and feet joints and surrounding soft tissue structures in RA and PsA different imaging modalities are used, which include projection radiography, ultrasonography (US), radionuclide techniques and magnetic resonance imaging (MRI). MRI has become the imaging modality of choice for evaluation of arthritis, when conventional radiography is not conclusive.

Zusammenfassung

Die beiden häufigsten und klinisch wichtigsten polyartikulär oder oligoartikulär an den kleinen Gelenken der Hände und Vorfüsse beginnenden, primär entzündlichen Erkrankungen sind die rheumatoide Arthritis (RA) und die Psoriasis-arthritis (PsA). Die wichtigsten histopathologischen Frühveränderungen sind unterschiedlich. Bei der RA umfassen sie die Synovialitis, gefolgt vom chronischen granulomatösen Entzündungsgewebe, dem Pannus, sowie sehr frühen Knorpel- und Knochendestruktionen, einschließlich subchondraler Knochendestruktionen. Bei der PsA sind frühe Enthesitiden das Hauptmerkmal der Erkrankung. Nach Diskussion der Möglichkeiten der konventionellen Röntgendiagnostik, des Ultraschalls und der Knochenszintigrafie kann gezeigt werden, dass die MRT unter Nutzung verschiedener Aufnahme-Frequenzen in der Lage ist, nicht nur Frühveränderungen der Gruppe rheumatischer Erkrankungen insgesamt bildgebend darzustellen, sondern dass sie auch bildgebend alle die RA und die PsA unterscheidenden histopathologischen Phänomene in einem Untersuchungsgang differentialdiagnostisch aufzuzeigen vermag.

Key words

rheumatoid arthritis - psoriatic arthritis - small joints of the hand and feet - differential diagnosis - magnetic resonance imaging

Schlüsselwörter

Rheumatoide Arthritis - Psoriasis-arthritis - kleine Gelenke der Hände und Vorfüsse - Differentialdiagnose - MRT

Full Text

References

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