An Imaging Study On Both Hands And Wrists In Early Stage Rheumatoid Arthritis

An imaging study on both hands and wrists in early stage rheumatoid arthritisObjective:To evaluate the value of the MR appearances, clinical symptom and laboratory test in diagnosing early stage rheumatoid arthritis of both hands and wrists. To search bone quality changes in patients with early rheumatoid arthritis by quantitative ultrasound of calcaneus, as well as to research the value of QUS for cinical. To search the reliable data to diagnose the early RA, and offer the important evidence for the right clincal diagnosis and early treatment.Materials and methods:1 Study object:(1)26 patients were diagnosed as early RA by clinical were selected, and the other 14 patients who were suspected as early RA were followed by 6～12 months and finally diagnosed. All the subjects with arthralgia in both hands and/or wrists, and their duration was 2 to 24 months. The MRI control group is 10 healthy people. (2) We selected 40 age-, sex-, BMI-marched healthy volunteers as the quantitative ultrasound control group.2 Examination methods:(1)A11 the patients and 10 healthy volunteers underwent pre-contrast and post-contrast MR examination.3.0-T MR scanner was used in pre-contrast performed by sequence of FSE-T1WI, FSE-T2WI and GRE-T2WI sequence in the coronal planes on both hands and wrists. After per-contrast examination, Enhanced MR examination was performed by the same unit (GE Medical System).3D LAVA and FSE-T1WI sequence coronal MR images were obtained 3-5 minutes after gadolinium injection interavenouly (0.2mmol/kg). (2) Measuring 40 early stage RA patients and 40 age-, sex-, BMI-marched healthy volunteers' bone quality by the OSTEOSPACE quantitative ultrasound, which was produced by the MEDILINK corporation in France.3 Observed index:(1) arthralgia and morning stiffness, sum of swelling joints, symmetric swelling joints, three or more swelling joints; erythrocyte sedimentation rate (ESR), C-reaction protein (CRP), serum rheumatoid factor (RF), anti CCP-Ab and anti RA33-Ab were counted. The location:distal radioulnar joint, wrists, metacarpophalangeal joint, interphalangeal joint were observed. (2) The following parameters were calculated:broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (STI), T-score, Z-score and so on.4 Statistical analysis:(1) Chi-square test in 2×2 table was used in statistical analysis of the correlation of MR imaging, clinical and laboratory test between the clinical diagnosed group and the following diagnosed group. Fisher exact probabilities was used when T<5. (2) Using t Test to analyze the differences of the QUS results, and chi-square test to analyze the incidence of OP between the RA group and non-RA group.Results:1. Among all the factors of clinical and laboratory test, the differences of symmetric swelling joints, three or more swelling joints, CRP and RF have statistical significance between the clinical diagnosed group and the following diagnosed group (P<0.05). However,all the MR features of both pre-and post-contrast MRI examination have no significant difference between the clinical diagnosed group and the following diagnosed group (P>0.05).2. When arthralgia and morning stiffness existing with RA, we got the higher frequency 87.5%. When bone erosion existing with the anti CCP-Ab, the frequency ofRA is 69.23%.3. As the post-contrast 3D LAVA imaging and its reformatted axial and sagittal planes to be the diagnosis standard, the diagnostic sensitivity and specificity of 3D MIP for synovitis were 91.49% and 97.72% respectively.4. BUA and STI in esrly RA patients were both lower than those in healthy people, and the differences were significant (P<0.05). The QUS results of bilateral calcaneus and the incidence of OP in the both group had no significant differences(P >0.05).5. The early stage RA patients was divided into the active-group and the non-active group on the basis of ESR>25mm/h. The BUA and STI were higher in active-group than in non-active group,the difference has statistical significance between the two groups(P<0.05).Conclusion:1. The main reason of delaying disease is that the clinical and laboratory tests are not characteristic. The post-MR imaging could supply a realiable basis to diagnose correctly and early therapy.2. Synovial hyperplasia and/or enhanced pannus in the hands and wrists existing with arthralgia and morning stiffness, as well as anti CCP-Ab, that should be the appearance of early RA. CRP is more sensitive to reflect the activity of early RA than ESR.3. The diagnostic sensitivity and specificity of 3D MIP for synovitis in bilateral hands and wrists are relatively higher.4. BUA is a sensitive factor to reflect the degree of bone loss in early RA patients. As a comprehensive index to evaluate bone quality, STI has some referential value to bone loss in the early RA too. As well as, the decrease of BUA and STI indicate RA in active stage.5. We should pay attention to the decrease of around bone quality. Therefore, therapy in time could prevent from OP and decrease the riskof OP fracture. Whatever calcaneus may reflect the change of bone quality.