Imaging in rheumatoid arthritis: options, uses and optimization

Abstract

Recent advances in imaging technology are dramatically changing the approach to patients with inflammatory arthritis. Conventional radiography is still the major imaging modality used to evaluate patients with rheumatoid arthritis in daily clinical practice. In the last decade, several investigations have shown the diagnostic ability of MRI and ultrasound to rectify the traditional approach to early diagnosis and disease activity monitoring. This review will summarize the options, uses and optimization of these imaging modalities with a special focus on ultrasound, which is currently the most promising tool to change the paradigms in both early diagnosis and therapy monitoring of rheumatoid arthritis.

Keywords:

• computed tomography
• conventional radiography
• magnetic resonance imaging
• rheumatoid arthritis
• ultrasound

Financial & competing interests disclosure

W Grassi declares no conflict of interest with respect to the submitted review. Relevant financial activities outside the submitted work for W Grassi include the following: payment for lectures including service on speakers bureaus by AbbVie, Bristol Myers Squibb, Menarini Group, MSD/Schering Plough, Pfizer/Wyeth, Savient, UCB Pharma, and Roche. E Filippucci declares no conflict of interest with respect to the submitted review. Relevant financial activities outside the submitted work for E Filippucci are as follows: payment for lectures including service on speakers bureaus by AbbVie, Bristol Myers Squibb, Merck Sharp & Dohme, UCB Pharma, and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Thanks to the recent advances in imaging technology, the approach to patients with rheumatoid arthritis (RA) has dramatically been changed in both diagnosis and monitoring.

• Ultrasound (US) and MRI allow for a careful confirmation of the clinical suspicion of RA by revealing even minimal pathologic changes indicative of soft tissue inflammatory involvement and/or joint damage.

• US has the ability to detect subclinical joint inflammation, and there are clear evidences of US utility for early diagnosis in RA.

• Subclinical power Doppler-positive synovitis on US might be considered a predictor of both radiographic joint damage progression and future relapse of disease activity in patients in remission.

• One of the major advantages of MRI compared with other techniques is the ability to assess bone edema/osteitis, which is related with bone damage progression.

Notes