title: Are rheumatoid arthritis patients discernible from other early arthritis patients using 1.5T extremity magnetic resonance imaging? a large cross-sectional study.
abstract: OBJECTIVE
  Magnetic resonance imaging (MRI) is increasingly used in rheumatoid arthritis (RA) research. A European League Against Rheumatism (EULAR) task force recently suggested that MRI can improve the certainty of RA diagnosis. Because this recommendation may reflect a tendency to use MRI in daily practice, thorough studies on the value of MRI are required. Thus far no large studies have evaluated the accuracy of MRI to differentiate early RA from other patients with early arthritis. We performed a large cross-sectional study to determine whether patients who are clinically classified with RA differ in MRI features compared to patients with other diagnoses.
  
  
  METHODS
  In our study, 179 patients presenting with early arthritis (median symptom duration 15.4 weeks) underwent 1.5T extremity MRI of unilateral wrist, metacarpophalangeal, and metatarsophalangeal joints according to our arthritis protocol, the foot without contrast. Images were scored according to OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) by 2 independent readers. Tenosynovitis was also assessed. The main outcome was fulfilling the 1987 American College of Rheumatology (ACR) criteria for RA. Test characteristics and areas under the receiver-operator-characteristic curves (AUC) were evaluated. In subanalyses, the 2010 ACR/EULAR criteria were used as outcome, and analyses were stratified for anticitrullinated protein antibodies (ACPA).
  
  
  RESULTS
  The ACR 1987 criteria were fulfilled in 43 patients (24.0%). Patients with RA had higher scores for synovitis, tenosynovitis, and bone marrow edema (BME) than patients without RA (p < 0.05). ACPA-positive patients had more BME (median scores 6.5 vs. 4.25, p = 0.016) than ACPA-negative patients. For all MRI features, the predictive value for the presence of RA was low (< 50%). For all MRI features the AUC were < 0.70. Patients who fulfilled ACR/EULAR 2010 criteria but not ACR87 criteria for RA had less synovitis than patients who were positive for RA according to both sets of criteria (p = 0.029).
  
  
  CONCLUSIONS
  Although patients with RA had higher scores of MRI inflammation and ACPA-positive patients had more BME, the severity of MRI inflammation assessed according to RAMRIS does not accurately differentiate patients with RA from other early arthritis patients.
authors.affiliation: From the Department of Radiology, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.W. Stomp, Researcher, MD, Department of Radiology, Leiden University Medical Center; A. Krabben, Researcher, MD; D. van der Heijde, Professor of Rheumatology, MD, PhD; T.W.J. Huizinga, Professor of Rheumatology, MD, PhD, Department of Rheumatology, Leiden University Medical Center; J.L. Bloem, Professor of Radiology, MD, PhD, Department of Radiology; A.H.M. van der Helm-van Mil, Rheumatologist, MD, PhD, Department of Rheumatology; M. Reijnierse, Radiologist, MD, PhD, Department of Radiology, Leiden University Medical Center. w.stomp@lumc.nl.
authors.forename: Wouter
authors.initials: W
authors.lastname: Stomp
authors.affiliation: From the Department of Radiology, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.W. Stomp, Researcher, MD, Department of Radiology, Leiden University Medical Center; A. Krabben, Researcher, MD; D. van der Heijde, Professor of Rheumatology, MD, PhD; T.W.J. Huizinga, Professor of Rheumatology, MD, PhD, Department of Rheumatology, Leiden University Medical Center; J.L. Bloem, Professor of Radiology, MD, PhD, Department of Radiology; A.H.M. van der Helm-van Mil, Rheumatologist, MD, PhD, Department of Rheumatology; M. Reijnierse, Radiologist, MD, PhD, Department of Radiology, Leiden University Medical Center.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Krabben
authors.affiliation: From the Department of Radiology, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.W. Stomp, Researcher, MD, Department of Radiology, Leiden University Medical Center; A. Krabben, Researcher, MD; D. van der Heijde, Professor of Rheumatology, MD, PhD; T.W.J. Huizinga, Professor of Rheumatology, MD, PhD, Department of Rheumatology, Leiden University Medical Center; J.L. Bloem, Professor of Radiology, MD, PhD, Department of Radiology; A.H.M. van der Helm-van Mil, Rheumatologist, MD, PhD, Department of Rheumatology; M. Reijnierse, Radiologist, MD, PhD, Department of Radiology, Leiden University Medical Center.
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: From the Department of Radiology, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.W. Stomp, Researcher, MD, Department of Radiology, Leiden University Medical Center; A. Krabben, Researcher, MD; D. van der Heijde, Professor of Rheumatology, MD, PhD; T.W.J. Huizinga, Professor of Rheumatology, MD, PhD, Department of Rheumatology, Leiden University Medical Center; J.L. Bloem, Professor of Radiology, MD, PhD, Department of Radiology; A.H.M. van der Helm-van Mil, Rheumatologist, MD, PhD, Department of Rheumatology; M. Reijnierse, Radiologist, MD, PhD, Department of Radiology, Leiden University Medical Center.
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.affiliation: From the Department of Radiology, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.W. Stomp, Researcher, MD, Department of Radiology, Leiden University Medical Center; A. Krabben, Researcher, MD; D. van der Heijde, Professor of Rheumatology, MD, PhD; T.W.J. Huizinga, Professor of Rheumatology, MD, PhD, Department of Rheumatology, Leiden University Medical Center; J.L. Bloem, Professor of Radiology, MD, PhD, Department of Radiology; A.H.M. van der Helm-van Mil, Rheumatologist, MD, PhD, Department of Rheumatology; M. Reijnierse, Radiologist, MD, PhD, Department of Radiology, Leiden University Medical Center.
authors.forename: Johan L
authors.initials: JL
authors.lastname: Bloem
authors.affiliation: From the Department of Radiology, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.W. Stomp, Researcher, MD, Department of Radiology, Leiden University Medical Center; A. Krabben, Researcher, MD; D. van der Heijde, Professor of Rheumatology, MD, PhD; T.W.J. Huizinga, Professor of Rheumatology, MD, PhD, Department of Rheumatology, Leiden University Medical Center; J.L. Bloem, Professor of Radiology, MD, PhD, Department of Radiology; A.H.M. van der Helm-van Mil, Rheumatologist, MD, PhD, Department of Rheumatology; M. Reijnierse, Radiologist, MD, PhD, Department of Radiology, Leiden University Medical Center.
authors.forename: Annette H M
authors.initials: AH
authors.lastname: van der Helm-van Mil
authors.affiliation: From the Department of Radiology, and the Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.W. Stomp, Researcher, MD, Department of Radiology, Leiden University Medical Center; A. Krabben, Researcher, MD; D. van der Heijde, Professor of Rheumatology, MD, PhD; T.W.J. Huizinga, Professor of Rheumatology, MD, PhD, Department of Rheumatology, Leiden University Medical Center; J.L. Bloem, Professor of Radiology, MD, PhD, Department of Radiology; A.H.M. van der Helm-van Mil, Rheumatologist, MD, PhD, Department of Rheumatology; M. Reijnierse, Radiologist, MD, PhD, Department of Radiology, Leiden University Medical Center.
authors.forename: Monique
authors.initials: M
authors.lastname: Reijnierse
mesh_terms: D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood / Q000276:immunology; D001168:Arthritis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology*; D001847:Bone Diseases / Q000175:diagnosis / Q000473:pathology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004487:Edema / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008662:Metacarpophalangeal Joint / Q000473:pathology; D008683:Metatarsophalangeal Joint / Q000473:pathology; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D012720:Severity of Illness Index; D013585:Synovitis / Q000175:diagnosis / Q000473:pathology; D014955:Wrist Joint / Q000473:pathology
chemical_list: D000888:Antibodies, Anti-Idiotypic; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide
keywords: ARTHRITIS; MAGNETIC RESONANCE IMAGING; METACARPUS; METATARSUS; RHEUMATOID ARTHRITIS; WRIST