MRI in the preclinical phase of RA
| Author, year | Study population | Cases (n) | Progression to arthritis (%) | Median duration from study entry to diagnosis of arthritis, months (IQR) | Median duration of follow-up, months (IQR) | MRI strength | Contrast enhancement | Locations scanned | Measured factors | Controls used to define positive MRI | Main result |
| van de Sande et al, 201139 | ACPA+ and/or RF+ arthralgia (secondary care) | 13* | 4 (31) | 3 (1–6)§ | 37 (25–45)§ | 1.5T | Y | Knee joint | Maximal enhancement, rate of enhancement, synovial volume and enhancement shape curve distribution | N | No differences in MRI findings between patients with and without progression to arthritis. |
| de Hair et al, 201429 | ACPA+ and/or RF+ individuals at risk for RA (secondary care and public fairs) | 55† | 15 (27) | 13 (6–27) | 27 (14–47) | 1.5T or 1T | Y | Arbitrary knee joint | Synovitis and hydrops in four compartments, BME, erosions and cartilage damage | N | None of the MRI parameters were associated with arthritis development. |
| Gent et al, 201440 | ACPA+ arthralgia (secondary care) | 28 | 12 (43) | NP | NP 3 years follow-up | 1.5T | Y | Wrist, MCP and PIP joints of both hands | Synovitis and BME according to RAMRIS | N | No difference in MRI-detected synovitis and BME scores in patients with and without progression to arthritis. |
| van Steenbergen et al, 201441 | ACPA-clinically suspect arthralgia (secondary care) | 64 | 5 (8) | NP | 9 (5–11) | 1.5T | Y | Wrist, MCP and MTP joints, of most painful side | Synovitis and BME according to RAMRIS | N | Higher scores for MRI inflammation (sum of BME and synovitis scores), synovitis and BME in patients who developed clinically detectable arthritis. |
| van Steenbergen et al, 201624 | Clinically suspect arthralgia (secondary care) | 150‡ | 30 (20)– | 1.7 (1–4) | 17 (9–24) | 1.5T | Y | Wrist, MCP and MTP joints, of most painful side | Synovitis and BME according to RAMRIS Tenosynovitis in wrist and MCP joints | Y | MRI-detected inflammation was associated with progression to arthritis, independent of age, symptom localisation, CRP and ACPA (HR 5.1, 95% CI 1.8 to 15). PPV of MRI-detected inflammation for arthritis development within 1 year: in all patients 31%; in ACPA+ patients 71%. |
*IgM-RF-positive and/or ACPA-positive individuals with arthralgia (n=12) or with a first-degree relative with RA with arthralgia (n=1).
†IgM-RF-positive and/or ACPA-positive individuals with arthralgia (n=34) or with a first-degree relative with RA with or without arthralgia (n=16). Information on family history of RA was missing for five patients in whom no arthritis developed.
‡One patient who developed gout during follow-up was excluded from analyses. In six patients MRI was not performed. Patients in refs 25 35 37 are all recruited via referral from the Academic Medical Center, Amsterdam, and from the rheumatology outpatient clinic of Reade. Patient in refs 19 38 39 are all included in the Leiden Clinically Suspect Arthralgia Cohort. The study depicted in grey has provided absolute risks.
§Median (range).
ACPA, anticitrullinated protein antibodies; CRP, C reactive protein; BME, bone marrow oedema; MCP, metacarpophalangeal; MTP, metatarsophalangeal; N, No; NP, not provided; PIP, proximal interphalangeal; PPV, positive predictive value; RA, rheumatoid arthritis; RAMRIS, rheumatoid arthritis MRI scoring system; RF, rheumatoid factor; Y, Yes.