title: Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years.
abstract: OBJECTIVE
  To determine whether magnetic resonance imaging (MRI) evidence of tendinopathy in early rheumatoid arthritis (RA) could be used to predict the course of tendon involvement in later disease and specifically the risk of tendon rupture.
  
  
  METHODS
  The occurrence, pattern, and progression of tendinopathy were studied prospectively over 6 years in a cohort of patients who had presented with RA. Of 42 patients enrolled, full MRI and clinical data were available for 31 at 6 years. MRI scans of the dominant wrist were scored for tendinopathy by 2 radiologists using a validated system. These data were compared with MRI synovitis, erosion scores, and disease activity measures. Prognostic factors for tendon inflammation and rupture were sought.
  
  
  RESULTS
  Thirty-four patients (81%) had MRI evidence of tendinopathy at baseline, falling to 59% at 1 year and 68% at 6 years. The most commonly affected site was the extensor carpi ulnaris. MRI tendinopathy and synovitis scores were correlated at baseline (r = 0.37, P = 0.01) and 1 year (r = 0.45, P = 0.003) but not at 6 years (r = 0.11, P = 0.5). The strongest predictor of the 6-year tendinopathy score was the 1-year tendinopathy score (R(2) = 0.36, P = 0.0003 [beta = 1.28, SE = 0.31]). In 4 patients, extensor tendon rupture had occurred by 6 years. Their baseline and 1-year tendinopathy scores were higher than in the nonrupture group (medians 2.8 versus 1.0 [P = 0.04] and 4.3 versus 0.8 [P = 0.03], respectively), as were their Health Assessment Questionnaire scores (1.33 versus 0.54 [P = 0.02], 1.18 versus 0.25 [P = 0.03], and 0.98 versus 0.37 [P = 0.01] at 0, 1, and 6 years, respectively). For the group as a whole, the baseline tendinopathy score was predictive of rupture at 6 years (odds ratio [OR] 1.52, 95% confidence interval [95% CI] 1.02-2.32, P = 0.03), as was the 1-year score (OR 1.57, 95% CI 1.03-2.04, P = 0.02).
  
  
  CONCLUSIONS
  MRI can be used to quantify tendinopathy at the wrist in RA patients. High scores in early disease were predictive of tendon rupture in a small group of patients, but further studies are required to determine whether this has clinical relevance.
authors.affiliation: University of Auckland and Auckland District Health Board, Auckland, New Zealand. f.mcqueen@auckland.ac.nz <f.mcqueen@auckland.ac.nz>
authors.forename: Fiona
authors.initials: F
authors.lastname: McQueen
authors.forename: Vaughan
authors.initials: V
authors.lastname: Beckley
authors.forename: Jeff
authors.initials: J
authors.lastname: Crabbe
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.forename: Sue
authors.initials: S
authors.lastname: Yeoman
authors.forename: Neal
authors.initials: N
authors.lastname: Stewart
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D013585:Synovitis / Q000175:diagnosis; D052256:Tendinopathy / Q000175:diagnosis*; D013717:Tenosynovitis / Q000175:diagnosis; D013997:Time Factors; D014955:Wrist Joint