title: Magnetic resonance imaging-detected inflammation is associated with functional disability in early arthritis-results of a cross-sectional study.
abstract: OBJECTIVE
  MRI sensitively detects inflammation, but the clinical relevance of MRI-detected inflammation is undetermined in early arthritis. Therefore, the aim of this cross-sectional study was to investigate the association between MRI-detected inflammation of hands and feet and functional disability in early arthritis.
  
  
  METHODS
  Five hundred and fourteen early arthritis patients, consecutively included in the Leiden Early Arthritis Clinic, were studied. At baseline a unilateral 1.5 T MRI of the wrist, MCP and MTP joints was performed and functional disability was measured using the HAQ. MRIs were scored for tenosynovitis, synovitis and bone marrow oedema (BME) by two readers. The sum of these types of MRI-detected inflammation yielded the total MRI-inflammation score. Linear and nonlinear regression analyses were performed with HAQ as outcome.
  
  
  RESULTS
  The total MRI-inflammation score was associated with the HAQ score (β = 0.014, P < 0.001), as were tenosynovitis (β = 0.046, P < 0.001), synovitis (β = 0.039, P < 0.001) and bone marrow oedema scores (β = 0.015, P < 0.001) separately. Analysing these three types of MRI-detected inflammation in one multivariable model revealed that only tenosynovitis was independently associated with the HAQ score (β = 0.039, P < 0.001). Also after correction for age, gender, joint counts, CRP and auto-antibodies, this association remained significant (β = 0.034, P < 0.001). MRI-detected inflammation at wrists or MCP joints associated significantly with impairments in hand functioning (e.g. difficulties with opening milk cartons or jars). Exploring the relation between MRI-detected inflammation and HAQ scores showed no evidence of a floor effect, suggesting that even low scores of MRI-detected inflammation are functionally relevant.
  
  
  CONCLUSIONS
  MRI-detected inflammation, and tenosynovitis in particular, is associated with functional disability. This demonstrates the functional relevance of MRI-detected inflammation in early arthritis.
authors.affiliation: Department of Rheumatology l.e.burgers@lumc.nl.
authors.forename: Leonie E
authors.initials: LE
authors.lastname: Burgers
authors.affiliation: Department of Rheumatology.
authors.forename: Wouter P
authors.initials: WP
authors.lastname: Nieuwenhuis
authors.affiliation: Department of Rheumatology.
authors.forename: Hanna W
authors.initials: HW
authors.lastname: van Steenbergen
authors.affiliation: Department of Rheumatology.
authors.forename: Elize C
authors.initials: EC
authors.lastname: Newsum
authors.affiliation: Department of Rheumatology.
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.affiliation: Department of Radiology.
authors.forename: Monique
authors.initials: M
authors.lastname: Reijnierse
authors.affiliation: Department of Medical Statistics.|Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: le Cessie
authors.affiliation: Department of Rheumatology.
authors.forename: Annette H M
authors.initials: AH
authors.lastname: van der Helm-van Mil
mesh_terms: D000203:Activities of Daily Living; D001172:Arthritis, Rheumatoid / Q000473:pathology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005534:Foot Diseases / Q000473:pathology / Q000503:physiopathology; D006225:Hand / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity; D013585:Synovitis / Q000473:pathology / Q000503:physiopathology; D013717:Tenosynovitis / Q000473:pathology / Q000503:physiopathology
keywords: foot; hand; magnetic resonance imaging; outcome measures; rheumatoid arthritis