title: Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis.
abstract: OBJECTIVE
  To evaluate the potential of MRI of finger and wrist joints for diagnosing early RA. MRI was evaluated as a stand-alone tool and in combination with ACR criteria and serum markers such as RF.
  
  
  METHODS
  Ninety-nine patients (31 men, 68 women; median age 46 years) with unspecified arthritis or suspected RA and negative X-ray findings were included. MR images of the hand and wrist of these patients were retrospectively evaluated for the presence of synovitis, erosions and tenosynovitis. The clinical diagnosis (early RA or non-RA) was made by a rheumatologist after clinical follow-up for 6-41 months. Clinical and laboratory data were collected from all patients.
  
  
  RESULTS
  Fifty-eight patients had a clinical diagnosis of RA and 41 were diagnosed as non-RA. Step-wise logistic regression of all MR parameters evaluated identified tenosynovitis of the flexor tendons to be the most powerful predictor of early RA (sensitivity = 60%, specificity = 73%). Including ACR criteria in the analysis, positive serum RF and tenosynovitis were the strongest predictors of early RA (sensitivity = 83%, specificity = 63%). When serum anti-cyclic citrullinated peptides (CCP), ANA and CRP were included as additional parameters, anti-CCP and flexor tenosynovitis were the strongest predictors of early RA (sensitivity = 79%, specificity = 73%).
  
  
  CONCLUSIONS
  Flexor tenosynovitis diagnosed by MRI of the hand is a strong predictor of early RA. Combining flexor tenosynovitis on MRI with positive serum anti-CCP or positive RF is an even stronger predictor of early RA.
authors.affiliation: Department of Radiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Eshed
authors.forename: Eugen
authors.initials: E
authors.lastname: Feist
authors.forename: Christian E
authors.initials: CE
authors.lastname: Althoff
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Eli
authors.initials: E
authors.lastname: Konen
authors.forename: Gerd-R
authors.initials: GR
authors.lastname: Burmester
authors.forename: Marina
authors.initials: M
authors.lastname: Backhaus
authors.forename: Kay-Geert A
authors.initials: KG
authors.lastname: Hermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis; D042241:Early Diagnosis; D005260:Female; D005384:Finger Joint / Q000473:pathology; D006225:Hand / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013710:Tendons / Q000473:pathology*; D013717:Tenosynovitis / Q000175:diagnosis*; D014955:Wrist Joint / Q000473:pathology; D055815:Young Adult