Tendon involvement in rheumatoid arthritis of the wrist: MRI findings

Objective. To evaluate the distribution and extent of wrist tendon alterati ons in patients with active rheumatoid arthritis (RA) using magnetic resona nce imaging (MRI). Design and patients. Forty-three clinically active RA patients with an illn ess duration of less than 4 years and no clinical evidence of tendons tears were enrolled in the study. There were 10 men and 33 women, with an averag e age of 52 years (range 33-63 years). MRI of both wrists, with one excepti on, was performed at 1.0 T using T1- and T2-weighted sequences (slice thick ness 3 mm). Twelve healthy subjects (8 women, 4 men; mean age 31 years) wer e also evaluated as a control group. Two radiologists reviewed each of four schematic anatomical regions (volar, dorsal, ulnar, radial) for the degree of tendon and tendon sheath alterations using two progressive scales. Results. In the control group all tendons had homogeneous low signal intens ity on all sequences. A small amount of fluid was found in six subjects but the diameter was always less than 1 mm. In the patient group minimal fluid (<2 mm) was found in 35 (41%) wrists, grade 2 fluid (<2>5 mm) in 26 (31%) and grade 3 fluid (>5 mm) in 24 (28%). Fifty-nine (69%) of the grade 1 chan ges were in the volar compartment but grade 2 involvement was evenly distri buted. Grade 3 changes were most common in the dorsal compartment and combi ned grade 2 and 3 in the dorsal and ulnar compartments were 32 (38%) and 25 (30%) compared with 16 (18%) and 17 (20%) respectively in the volar and ra dial compartments. The tendons were normal (grade 0) in 47 (46%) wrists. A maximum tendon signal change (grade 1) was demonstrated in 28 wrists (32%). When associated with other individual tendons grades this grade was demons trated in the dorsal compartment in 30 (35%) wrists, in the volar compartme nt in 12 (14%), in the radial compartment in 17 (20%) and in the ulnar comp artment in 26 (30%). A partial tear (grade 2) was detected in 7 (8%) wrists , all involving the dorsal and ulnar compartments; five underwent surgical repair and one proved to have a complete rupture of extensor digitorum. Thr ee (3%) had a grade 3 complete tendon tear: all of these were in extensor t endons. Surgical repair was successful in one case but two ruptured again w ithin 3 months. Conclusions. Low grades of peritendinous effusion were more common in the v olar compartment whereas moderate and high degrees of tendon sheath fluid c ollection and/or pannus and signs of tendonitis were more frequent in the d orsal and ulnar tendon sheaths.