Characterising arthralgia in the preclinical phase of rheumatoid arthritis using MRI.
BACKGROUND
The phase of arthralgia is the earliest moment to clinically recognize patients who may develop Rheumatoid Arthritis (RA). Previous imaging studies in the arthralgia phase have shown that inflammation precedes RA development. It is unknown which symptoms/characteristics relate to subclinical joint inflammation as measured by MRI. Among all patients with arthralgia, those with clinically suspect arthralgia (CSA) are suspected to progress to arthritis according to the clinical judgement of their rheumatologists. We determined the symptoms/characteristics of patients with CSA who had inflammation on MRI.


METHODS
102 patients with CSA and without clinical arthritis were included. They completed questionnaires, underwent joint counts and unilateral 1.5 T MRI of MCP joints 2-4, wrist and MTP joints 1-5. Synovitis, bone marrow oedema (BME) and tenosynovitis were scored according to the OMERACT rheumatoid arthritis MRI scoring system. Symptoms and signs were related to MRI inflammation (based on MRI scores in symptom-free controls; a sum of synovitis, BME and tenosynovitis scores ≥3 was considered positive). Whether certain clinical characteristics frequently occurred together with MRI inflammation was studied by partial least squares analysis.


RESULTS
MRI was performed in 93 patients with CSA, 44% of whom had subclinical MRI inflammation. Synovitis was the most prevalent inflammatory feature on MRI (20%). Patients with MRI inflammation were older and were more frequently positive for anti-citrullinated peptide antibodies than patients without MRI inflammation (p<0.001 and 0.049). In PLS analysis, including 16 clinical and serological characteristics as independent variables and MRI inflammation as dependent variable, no clear clusters of patients with and without MRI inflammation were identified.


CONCLUSIONS
Subclinical inflammation as measured by MRI is present in 44% of patients with CSA. A combination of symptoms/characteristics incompletely differentiated patients with and without MRI inflammation.
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Hanna W
HW
van Steenbergen
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Jessica A B
JA
van Nies
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Tom W J
TW
Huizinga
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Johan L
JL
Bloem
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Monique
M
Reijnierse
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Annette H M
AH
van der Helm-van Mil
D000328:Adult; D018771:Arthralgia / Q000175:diagnosis* / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis*; D001853:Bone Marrow / Q000473:pathology*; D001855:Bone Marrow Diseases / Q000175:diagnosis* / Q000209:etiology; D042241:Early Diagnosis; D004487:Edema / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D050823:Hand Joints / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D062706:Prodromal Symptoms; D012720:Severity of Illness Index; D013585:Synovitis / Q000175:diagnosis* / Q000209:etiology; D013717:Tenosynovitis / Q000175:diagnosis* / Q000209:etiology
Arthritis; Inflammation; Magnetic Resonance Imaging; Rheumatoid Arthritis