SLR - May 2022 - Faramarz Fanaian, DPM
Reference: Yousra J. Dakkak, Xanthe M.E. Matthijssen, Désirée van der Heijde, Monique Reijnierse and Annette H.M. van der Helm-van Mil. The Journal of Rheumatology August 2020, 47 (8) 1165-1173; DOI: https://doi.org/10.3899/jrheum.190258Reviewed By: Faramarz Fanaian, DPM
Residency Program: New York College of Podiatric Medicine – New York, NY
Podiatric Relevance: The Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) is validated for hand MRI. Its reliability applied to metatarsophalangeal (MTP 1–5) joints is unknown and was studied in early arthritis and clinically suspect arthralgia
Methods: Patients underwent 1.5 Tesla MRI of MTP, metacarpophalangeal (MCP 2–5), and wrist joints. Two paired readers scored bone marrow edema (BME), synovitis, tenosynovitis, and erosions. Interreader reliability was assessed of 441 consecutive early arthritis patients at baseline, 215 by 2 readers, and the remaining 226 by 2 different readers. Two readers scored baseline MRI of 82 consecutive patients with clinically suspect arthralgia, and 40 randomly selected patients by 9 readers. Intrareader reliability was determined on a random set of 15 early arthritis patients, scored twice by 2 readers. For change scores, 30 early arthritis patients with baseline and 1-year follow up MRI were scored by 2 readers. Intraclass correlation coefficients (ICC), Bland-Altman (BA) plots, and smallest detectable change (SDC) were determined. MRI data of MTP joints were compared to wrist and MCP joints.
Results: Interreader ICC and mean scores in early arthritis were BME ICC 0.91–0.92 (mean 1.5 ± SD 2.6), synovitis 0.90–0.92 (1.3 ± 1.7), tenosynovitis 0.80–0.85 (1.1 ± 1.8), and erosions 0.88–0.89 (0.7 ± 1.0). In patients with clinically suspect arthralgia, ICC were comparable. Intrareader ICC for inflammatory MRI features were 0.84–0.98, for erosions 0.71 (reader 1), and 0.92 (reader 2). Change score ICC were ≥ 0.90, except erosions (0.77). SDC were ≤ 1.0. BA plots showed no systematic bias. Reliability scores of MTP joints were similar to MCP and wrist joints.
Conclusions: This longitudinal inception cohort included patients with clinically confirmed arthritis and symptom duration < two years who were naive to disease-modifying antirheumatic drugs (DMARD). At baseline, questionnaires were completed, swollen joint counts were performed, and serum samples were obtained. Unilateral 1.5 Tesla (1.5T) MRI of the MTP, MCP, and wrist joints of the most painful side, or the dominant side in the case of equally severe symptoms on both sides, was made of patients who were consecutively included from June 2013 onward15. Before contrast administration, T1-weighted fast spin echo (FSE) sequences in the coronal plane were acquired for MCP and wrist joints. After intravenous injection of gadolinium contrast, T1-weighted FSE sequences with frequency selective fat saturation were acquired in coronal and axial planes of the MCP, wrist, and MTP joints. Patients were asked to stop nonsteroidal antiinflammatory drugs (NSAID) 24 h before the scan, and the MRI was made before the start of DMARD.