Early diagnosis of rheumatoid arthritis (RA) is important given the availability of highly effective disease-modifying antirheumatic (DMARD) medications, including biologics. However, because of associated risks and cost, accurately assessing disease activity is critical. Because magnetic resonance imaging (MRI) can detect synovitis and bone marrow edema, both of which may precede erosion development, we sought to determine the impact of enhanced MRI on patient management in a group of patients referred for MRI by rheumatologists.
After institutional review board approval, we evaluated all hand MRI examinations referred by the rheumatology department for synovitis evaluation between September 2007 and May 2009. The magnetic resonance images were classified as positive or negative and later reviewed by 2 musculoskeletal radiologists. A musculoskeletal radiologist and rheumatologist jointly reviewed the patients' medical records to determine the following: (1) Did the MRI findings alter treatment? (2) Were the treatment alterations beneficial?
The study included 48 patients (39 women and 9 men) with a mean age of 51 years (range, 18-79 years). Significant management changes initially occurred in 79% (23/29) of the positive (DMARDs added in 20) and in 11% (2/19) of the negative MR examinations with average follow-up of ~300 days. Eighty percent (16/20) of the patients with DMARDs added experienced symptom improvement, none of the patients whose medications were discontinued experienced symptom relapse, and 18% (4/22) of patients without initial therapeutic changes required delayed treatment modifications.
Enhanced MRI significantly altered clinical management in 50% of these patients with RA or suspected RA. Therefore, when the clinical picture in a patient with RA or suspected RA is unclear, enhanced MRI can provide useful guidance for treatment modifications.