Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


MRI and X-Ray Measured Changes in Joint Space Narrowing Are Closely Associated in Early RA Patients: A Pilot Study.

Lillegraven2,  Siri, Boyesen2,  Pernille, Ostergaard3,  Mikkel, Sesseng2,  Sølve, Kvien1,  Tore K., Haavardsholm2,  Espen A.

Diakonhjemmet Hospital, Oslo, Norway
Diakonhjemmet Hospital, Oslo, Norway
Hvidovre University Hospital, Hvidovre, Denmark

Background:

Magnetic Resonance Imaging (MRI) is commonly used to assess erosions, synovitis, tenosynovitis and bone marrow edema in rheumatoid arthritis (RA) patients. During the development of the OMERACT RA MRI score (RAMRIS) joint space narrowing (JSN) was tested, but left out due to insufficient image resolution. However, MRI image quality has now improved, and a MRI JSN score with encouraging inter-reader reliability was presented at the 2010 OMERACT meeting.

Objectives:

To investigate the intra- and inter-reader reilability of the OMERACT JSN score in a longitudinal setting, and to assess the association with X-ray changes.

Methods:

10 patients were selected from a cohort of early RA patients (disease duration less than one year at baseline) with 5-year follow-up. The patients were examined by X-ray of both hands and MRI of the dominant wrist (GE Signa 1.5 T MRI scanner). The 10 patients were chosen according to 5-year change of van der Heijde Sharp JSN score (hands only), with two patients selected from the two lowest quartiles, and three patients from each of the two highest quartiles. The MRI images were assessed on coronal T1-weighted sequences by two readers (PB and SL), both familiar with the RAMRIS score and with experience from previous JSN exercises. 18 joint sites in the wrist were scored 0 (no JSN) - 4 (ankylosis/total loss of joint space). The images were assessed twice on consecutive days, with anonymization and randomization between the readings. Intra-class correlation coefficients were calculated for intra-reader (single measures), inter-reader (average measures) reliability and association to X-ray (average measures).

Results:

The median (25th percentile, 75th percentile) age was 54 (47, 67) years, disease duration 98 (48, 139) days, 8 were female and 4 were anti-ccp positive. 5-year change in van der Heijde Sharp JSN score ranged from 0 to 20, with a median of 4. Table 1 shows the intra-reader ICCs, inter-reader ICCs and comparison of MRI scorings and X-ray for each reader.

Table 1. Intra-reader ICCs, inter-reader ICCs and comparison of MRI and X-ray JSN score.

 Intra-reader ICCInter-reader ICCMRI vs. X-ray ICC
 Reader 1Reader 2 Reader 1Reader 2
Baseline0.600.750.670.680.40
5 year0.870.910.950.850.82
Change0.900.970.990.910.94

The figure shows an example patient with x-ray and MRI images.

Figure. Patient example with development of JSN at several wrist joints: MRI images from baseline (A) and 5-year follow-up (B) left, X-ray images from baseline (C) and 5-year follow-up (D).

Few of the patients had much change in JSN assessed by MRI, with a median change (range)[25th percentile, 75th percentile] for scorer 1 of 0 (0–30) [0, 1.25] and for scorer 2 1.5 (0 – 28) [0.75, 3.5].

Conclusion:

This small study shows promising results for the assessment of JSN on MRI, with strong association between change in JSN on MRI and X-ray. However, these results need to be confirmed in other cohorts, especially including patients with more JSN.

To cite this abstract, please use the following information:
Lillegraven, Siri, Boyesen, Pernille, Ostergaard, Mikkel, Sesseng, Sølve, Kvien, Tore K., Haavardsholm, Espen A.; MRI and X-Ray Measured Changes in Joint Space Narrowing Are Closely Associated in Early RA Patients: A Pilot Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :132
DOI: 10.1002/art.27901

Abstract Supplement

Meeting Menu

2010 ACR/ARHP