Rheumatology Advance Access published online on May 2, 2006
Rheumatology, doi:10.1093/rheumatology/kel137
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1 Oulu University Hospital, Oulu, Finland
* To whom correspondence should be addressed. Objectives. To investigate if disease assessment by contrast-enhanced dynamic and static magnetic resonance imaging (MRI) and quantitative nanocolloid (NC) scintigraphy gives useful additional information in early rheumatoid arthritis (RA). Methods. Twenty-seven patients with early RA (disease duration Results. The baseline MRI bone oedema score ( Conclusion. The degree of local synovial inflammation at baseline, evaluated by dynamic and static MRI and quantitative NC scintigraphy, is closely related to the progression of wrist joint erosions during the first 2 yrs of the disease. Furthermore, at follow-up, if no persistent clinical response is achieved, these imaging methods may help to predict future erosiveness and help in clinical therapeutic decision making.
Received June 2, 2005
Accepted March 24, 2006
Original Papers
Bone oedema predicts erosive progression on wrist MRI in early RA--a 2-yr observational MRI and NC scintigraphy study
Kari Palosaari 1 *,
Jorma Vuotila 2,
Reijo Takalo 1,
Airi Jartti 1,
Raija K Niemelä 1,
Anna Karjalainen 1,
Marianne Haapea 1,
Irma Soini 2,
Osmo Tervonen 1,
and
Markku Hakala 2
2 Rheumatism Foundation Hospital, Heinola, Finland
Kari Palosaari, E-mail: kari.palosaari{at}oulu.fi
Abstract 
12 months) were followed up for 1 yr and 24 of them for 2 yrs with contrast-enhanced MRI and NC scintigraphy of the wrist joint. Synovial inflammation was assessed by measuring time-dependent enhancement rates (E-rate) from dynamic MRI scans and technetium99m-labelled nanocolloid (99mTc-NC) uptake from scintigraphy scans. Synovial membrane hypertrophy, bone oedema and erosions were semiquantitatively scored according to the Outcome Measures in Rheumatology Clinical Trials RA-MRI scoring system from static MR images. Response to the treatment was evaluated based on whether or not 
50% improvement was achieved in the tender and swollen joint scores and the Health Assessment Questionnaire score, with normal C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) levels. Progression of the erosion score on wrist MRI was evaluated as the outcome.
= 0.67), MRI synovitis score ( = 0.57), ESR ( = 0.56), CRP ( = 0.48), E-rate ( = 0.47) and 99mTc-NC uptake ( = 0.45) were related with the change in the MRI erosion score from baseline to 2 yrs ( = Spearman's correlation). In the multivariate logistic regression model, the bone marrow oedema score was the only baseline variable that predicted erosive progression at 2 yrs’ follow-up (OR 4.2, 95% CI 1.3-13.8). The median (interquartile range) change in the erosion score from baseline to 2 yrs was 0 (0, 0) and 4 (2, 5) in the patients with (n = 9) and without (n = 15) a persistent clinical response over the 2 yrs, respectively (P = 0.001). The non-responders who presented with erosive progression from 1 yr to 2 yrs had higher MRI synovitis scores, bone oedema scores, E-rate and 99mTc-NC uptake at 1-yr follow-up than the non-responders without progressive bone damage.
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