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The impact of MRI on the clinical management of inflammatory arthritides

Weber, Ulrich ; Østergaard, Mikkel ; Lambert, Robert ; Maksymowych, Walter

In: Skeletal Radiology, 2011, vol. 40, no. 9, p. 1153-1173

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    Titre
    • The impact of MRI on the clinical management of inflammatory arthritides
    Auteur
    • Weber, Ulrich. Department of Medicine, Division of Rheumatology, University of Alberta, 562 Heritage Medical Research Centre, T6G 2S2, Edmonton, AB, Canada
    • Østergaard, Mikkel. Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
    • Lambert, Robert. Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
    • Maksymowych, Walter. Department of Medicine, Division of Rheumatology, University of Alberta, 562 Heritage Medical Research Centre, T6G 2S2, Edmonton, AB, Canada
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:311421
    Summary
    In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides