CONTRAST-ENHANCED GD-DTPA MAGNETIC-RESONANCE-IMAGING IN THE EVALUATION OF RHEUMATOID-ARTHRITIS DURING A CLINICAL-TRIAL WITH DMARDS - A PROSPECTIVE 2-YEAR FOLLOW-UP-STUDY ON HAND JOINTS IN 31 PATIENTS

Objective. The aim of this prospective 24-month follow-up study was to compare clinical features with radiological and magnetic resonance im aging (MRI) findings in evaluating synovial proliferation in the hand joints of 31 patients with rheumatoid arthritis (RA). A single joint w as used for the follow-up of each patient. Methods. Thirty-one small h and joints were examined by conventional radiography and MRI before an d after 24 months of treatment. MRI assessment of disease progression (volume and/or signal intensity of the synovial proliferation on T1 we ighted precontrast, T1 weighted postcontrast and T2 weighted images) w as compared with a clinical assessment of the chosen joints, and with a plain x-ray film evaluation (Larsen's score). Results. Of 26 joints which clinically improved (14 markedly and 14 slightly) during the stu dy, on MRI 16 showed improvement, 8 showed no change, and 2 showed det erioration. Four clinically unchanged joints appeared improved on MRI. One joint deteriorated clinically and on MRI. Overall, there was a 58 % congruence between clinical and MRI findings. On x-ray 23 joints sho wed no change; nine of these were also unchanged on MRI, while 13 show ed improvement and one deterioration. Only in 2 out of 8 joints showin g deterioration on x-ray were the MRI findings in accordance. In the r emaining six joints MRI showed improvement. The congruence between x-r ay and MRI was therefore 36%. Conclusion. The long-term follow-up of r heumatoid synovial proliferation of the small joints in the hand using contrast enhanced MRI is feasible and may provide additional informat ion regarding disease activity. Important advantages over conventional radiography methods are its ability to demonstrate qualitative differ ences of synovial proliferation within bone erosions, and demonstrate not only deterioration, but also the improvement of inflammatory disea se.