Magnetic resonance imaging in rheumatoid arthritis: Current status and future directions

The performance of alternative imaging endpoints in clinical trials can be compared in terms of validity, rate of change, measurement precision, and c onvenience and cost. With respect to performance magnetic resonance imaging (MRI) appears to show greater sensitivity than radiography for detecting b one abnormalities in rheumatoid arthritis (RA). In addition to monitoring c hanges in the bones, cartilage, and synovium, MRI can directly visualize th e full spectrum of tendon pathology, and has been shown to identify tendoni tis and tendon rupture with greater accuracy than clinical examination. MRI is currently, regarded to be the most sensitive imaging technique for iden tifying trauma, infection, ischemia, and primary and secondary neoplasia of bone. Several studies have also shown MRI to be highly sensitive for detec ting what appeal to be bone erosions in the hands and wrists of patients wi th RA. MRI shows remarkable promise as a tool for identifying and monitorin g structural damage in the joints of patients with RA. MRI appears to be ab le to identify bone erosions with greater sensitivity than radiography, and to disclose edema-like changes in the marrow, which may precede actual ero sion formation. As new therapies with structure modifying capabilities ente r the clinic, the ability to identify patients appropriate for those therap ies and then to monitor the effectiveness and safety of treatment become in creasingly important.