Older age is associated with more MRI-detected inflammation in hand and foot joints.
OBJECTIVE
Although MRI is recommended for diagnostic use in detecting joint inflammation, its value in clinical practice has not been settled. Older symptom-free persons show more MRI-detected inflammation in their hands and feet. Within arthritis patients, a similar effect could be present (a general age effect). The association of age with MRI inflammation could also be enhanced by disease (disease-dependent age effect). Because both effects could have diagnostic consequences, we evaluated the association between age-at-onset and MRI-detected inflammation in early arthritis and RA.


METHODS
Unilateral contrast-enhanced MRI of the MCP joint, wrist and MTP joints was performed in 589 newly presenting early arthritis patients, of whom 229 had RA. Bone marrow oedema, synovitis and tenosynovitis were summed, yielding the MRI inflammation score. MRI findings were associated with age and compared with those of 193 (previously reported) symptom-free controls.


RESULTS
Early arthritis and RA-patients had, respectively, 2.6 (95% CI: 2.3, 3.0, P < 0.001) and 3.7 times (95% CI: 3.2, 4.3, P < 0.001) higher MRI inflammation scores than controls (adjusted for age). At higher age of onset, early arthritis and RA patients had higher MRI inflammation scores (1.03/year, P < 0.001). A similar effect was observed in controls (1.03/year, P < 0.001). The interaction term age*group (arthritis/RA vs controls) was non-significant (P = 0.80 and P = 0.23), suggesting that the age effect was not disease dependent. At the joint level, older RA patients had more extended MRI inflammation, but the preferential locations were similar.


CONCLUSIONS
Older age is associated with more MRI-detected inflammation, and the effect was similar in arthritis and controls. This age effect should be considered when interpreting hand and foot MRI for diagnostic purposes.
Department of Rheumatology W.P.Nieuwenhuis@lumc.nl.
Wouter P
WP
Nieuwenhuis
Department of Rheumatology.
Lukas
L
Mangnus
Department of Rheumatology.
Hanna W
HW
van Steenbergen
Department of Rheumatology.
Elize C
EC
Newsum
Department of Rheumatology.
Tom W J
TW
Huizinga
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Monique
M
Reijnierse
Department of Rheumatology.
Annette H M
AH
van der Helm-van Mil
D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000473:pathology*; D016022:Case-Control Studies; D003287:Contrast Media; D042241:Early Diagnosis; 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; D013585:Synovitis / Q000473:pathology; D013717:Tenosynovitis / Q000473:pathology; D055815:Young Adult
D003287:Contrast Media
aging; early arthritis; magnetic resonance imaging; rheumatoid arthritis