Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement

Objectives-To investigate the progression of joint damage in early rheumato id arthritis (RA) using magnetic resonance imaging (MRI) of the wrist and d etermine whether this technique can be used to predict prognosis. Methods-An inception cohort of 42 early patients has been followed up prosp ectively for one year. Gadolinium enhanced MRI scans of the dominant wrist were obtained at baseline and one year and scored for synovitis, tendonitis , bone marrow oedema, and erosions. Plain radiographs were performed concur rently and scored for erosions. Patients were assessed clinically for disea se activity and HLA-DRB1 genotyping was performed. Results-At one year, MRI erosions were found in 74% of patients (31 of 42) compared with 45% at baseline. Twelve patients (28.6%) had radiographic ero sions at one year. The total MRI score and MRI erosion score increased sign ificantly from baseline to one year despite falls in clinical measures of i nflammation including erythrocyte sedimentation rate (ESR), C reactive prot ein (CRF), and swollen joint count (p < 0.01 for all). Baseline findings th at predicted carpal MRI erosions at one year included a total MRI score of 6 or greater (sensitivity: 93.3%, specificity 81.8%, positive predictive va lue 93.3%, p = 0.000007), MRI bone oedema (OR = 6.47, p < 0.001), MRI synov itis (OR = 2.14, p = 0.003), and pain score (p 0.01). Radiological erosions at one year were predicted by a total MRT score at baseline of greater tha n 13 (OR = 12.4, p = 0.002), the presence of MRI erosions (OR 11.6, p = 0.0 05), and the ESR (p = 0.02). If MRI erosions were absent at baseline and th e total MRI score was low, radiological erosions were highly unlikely to de velop by one year (negative predictive value 0.91 and 0.92 respectively). N o association was found between the shared epitope and erosions on MRT (p = 0.4) or radiography (p = 1.0) at one year. Conclusions-MRI scans of the dominant wrist are useful in predicting MRI an d radiological erosions in early RA and may indicate the patients that shou ld be managed aggressively. Discordance has been demonstrated between clini cal improvement and progression of MRI erosion scores.