The Evaluation Of MRI In Diagnosis Of Rheumatoid Arthritis

Objective:In order to guide clinical work and provide the evidence of early diagnosis of RA,this study do further analysis of the MRI features,clinical symptoms and laboratory tests in different RA patient groups,and find the relationship between the hand-MRI and early joint destruction.Methods:This study included 25 cases of RA patients, and collected disease duration, swollen joint count(swollen joint count, SJC),tender joint counts(tender joint count, TJC),visual scale(visual analog scale, VAS) score, 28 joints disease activity score (DAS28 score), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), rheumatoid factor classification(RF classification), anti-cyclic citrullinated peptide antibodies(anti-cyclic citrullinated protein antibodies, anti-CCP antibodies, anti-CCP antibodies), X-ray of hands and wrist of the patients,then analyze the signs of MRI change and these indicators to further discuss the value of MRI in the diagnosis of RA. Meanwhile, to analyze the MRI signs differences between the two groups of positive or negative in IgG-RF, IgA-RF, IgM-RF and anti-CCP antibody.The results showed:1. Sensitivity of MRI bone erosion signs was 68.0% and the most bones to be involved was capitate bone, scaphoid bone, lunate bone. In 18 cases of early RA patients, capitate bone, triangular bone, scaphoid bone, lunate bone were affected more easier.2. The most bone marrow edema occurred in the capitate bone, triangular bone, lunate bone.3. Radiocarpal synovitis were present in patients of the course of disease more than a year, while in 18 cases of early RA patients, wrist synovitis can be found.4. The difference of arthroedema had statistically significant between the group of early RA and the group of course more than 1 year. The sensitivity of wrist arthroedema is 88.0%; in 18 cases of early RA patients, the sensitivity of wrist arthroedema was 87.1%.5. In the 16 patients of non-performance in X-ray, 10 cases (62.5%) had bone erosion, 13 cases (81.25%) had bone marrow edema, 13 cases (81.25%) had synovitis and 13 cases (81.25%) had joint arthroedema.6. No matter the duration of disease was less than 1 year or more than 1 year, the difference of bone erosion had statistically significant between the anti-CCP antibody-positive group and anti-CCP antibody negative group.7. No matter the duration of disease was less than 1 year or more than 1 year, the differences of synovitis had statistically significant between the IgG-RF positive group and IgG-RF negative group.8. The titer of IgA-RF was positively correlated with bone marrow edema.9. VAS had positive correlation with bone marrow edema.10. CRP had positive correlation with the number of arthroedema.Conclusion:1. Sensitivity of MRI bone erosion signs was 68.0% and the most bones to be involved is capitate bone, scaphoid bone, lunate bone. In 18 cases of early RA patients, capitate bone, triangular bone, scaphoid bone, lunate bone are affected more easier. Prompts that the wrist, especially in the capitate bone, triangular bone, scaphoid bone and lunate bone is the most frequent sites of bone erosion.2. Bone marrow edema of the carpal was significantly higher than metacarpal and phalanx. Prompt us that the carpal, especially capitate bone, scaphoid bone, lunate bone, is the most frequent sites of bone marrow edema.3. Synovitis of the wrist-metacarpus joints was significantly earlier than the antibrachio-carpal joints, prompts that we should focus the appearance of synovitis of the wrist-metacarpus joints in early RA patients.4. The sensitivity of carpal arthroedema was more higher in RA patients, especially in the course of disease less than 1 year.5. The importance of diagnosis of MRI was much larger than the X-ray examination in the paitents which the duration is less than 1 year, at the same time. Prompt that we should be pay close attention to the carpal joints in clinical work in patients which the course of RA is less than 1 year or the patients with non-performance of X-ray, because the carpal joints are more frequent sites of involvement than other joints.6. Anti-CCP antibody positive group had higher bone erosion than anti-CCP antibody-negative group, the titer was positively correlated with bone erosion.Prompt that anti-CCP antibodies appear more likely when the MRI bone erosion.7. This study also found that, the differences of synovitis had statistically significant between the IgG-RF positive group and IgG-RF negative group, and in patients which duration were less than 1 year, the differences of synovitis has statistically significant between the IgG-RF & IgM-RF positive group and negative group. Prompt IgG-RF could reflect the occurrence of MRI synovitis; IgG-RF and IgM-RF could reflect the occurrence of MRI synovitis in the patients which course of the disease less than 1 year.8. The titer of IgA-RF was positively correlated with bone marrow edema.9. MRI bone marrow edema was positively correlated with VAS score, indicating the degree of MRI bone marrow edema as a major factor of VAS scroe.10. The level of CRP can reflect the number of affected joints of MRI arthroedema.11. This study shows that, more longer course of disease of RA, means more involved bones and more serious of destruction. Therefore early diagnosis and treatment is more essential to alleviate pain and reduce disability in patients. In the early diagnosis, MRI has an absolute advantage; also has significant value to reduce the rate of mutilation and reduce the burden of treatment in the future.