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ORIGINAL PAPER
Low-field magnetic resonance and high-resolution ultrasound imaging of the wrist, metacarpophalangeal and proximal interphalangeal joints combined with anti-cyclic citrullinated peptide antibodies and rheumatoid factors in the diagnosis of early rheumatoid arthritis in patients with undifferentiated polyarthritis
Online publication date: 2009-06-10
Reumatologia 2009;47(2):51-59
KEYWORDS
ABSTRACT
Objective: The purpose of the study was to assess the utility of low-field magnetic resonance (MR) and high-resolution ultrasound (US) of the wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, anti-cyclic citrullinated peptide antibodies (aCCP IgG, aCCP IgG/IgA) and rheumatoid factors (IgG, IgA, IgM) in the diagnosis of early rheumatoid arthritis (RA) in patients with undifferentiated polyarthritis with a strong clinical suspicion of RA with no erosions on hand X-ray.
Material and methods: The following inclusion criteria were used: 1) age > 18 years, 2) inflammation > 4 joints, 3) inflammation of wrist, MCP or PIP joints, 4) morning stiffness > 30 min, 5) arthritis onset > 12 weeks, 6) lack of erosions on hand X-ray on referral. In 21 patients MR, US and digital X-ray of the wrist, MCP and PIP joints were performed along with blood RF IgM, RF IgG and RF IgA, aCCP IgG and aCCP IgG/IgA assessment.
Results: The highest number of erosions was detected in MRI; the average number of erosions per patient in MRI and US was 11.85 and 2.42 respectively (p < 0.05). In each technique the majority of erosions were detected within the wrist: 83% in X-ray, 49% in US and 76% in MRI. Only for US was there a significant correlation between duration of joint inflammation and the number of erosions. aCCP IgG and aCCP IgG/IgA were found in 12 and 14 patients, respectively, and RF IgM in 14, RF IgA in 17 and RF IgG in 20 patients. The results of aCCP IgG and aCCP IgG/IgA revealed a statistically significant difference in favour of aCCP IgG/IgA. There was no correlation between rheumatoid factors and aCCP IgG or aCCP IgG/IgA. The correlation between the number of erosions in MRI and the concentration of immunological markers (aCCP and RF) in the blood was statistically significant only for aCCP IgG (r = –0.5, p = 0.02); no similar correlations were revealed for X-ray and US.
Conclusions: The best technique for detection of erosions, especially in the wrist region in undifferentiated polyarthritis, is MRI in comparison to X-ray and US. Positive results of aCCP3 (IgG/IgA) in undifferentiated polyarthritis are more frequent and are present in higher values than positive results of aCCP2 (IgG).
Material and methods: The following inclusion criteria were used: 1) age > 18 years, 2) inflammation > 4 joints, 3) inflammation of wrist, MCP or PIP joints, 4) morning stiffness > 30 min, 5) arthritis onset > 12 weeks, 6) lack of erosions on hand X-ray on referral. In 21 patients MR, US and digital X-ray of the wrist, MCP and PIP joints were performed along with blood RF IgM, RF IgG and RF IgA, aCCP IgG and aCCP IgG/IgA assessment.
Results: The highest number of erosions was detected in MRI; the average number of erosions per patient in MRI and US was 11.85 and 2.42 respectively (p < 0.05). In each technique the majority of erosions were detected within the wrist: 83% in X-ray, 49% in US and 76% in MRI. Only for US was there a significant correlation between duration of joint inflammation and the number of erosions. aCCP IgG and aCCP IgG/IgA were found in 12 and 14 patients, respectively, and RF IgM in 14, RF IgA in 17 and RF IgG in 20 patients. The results of aCCP IgG and aCCP IgG/IgA revealed a statistically significant difference in favour of aCCP IgG/IgA. There was no correlation between rheumatoid factors and aCCP IgG or aCCP IgG/IgA. The correlation between the number of erosions in MRI and the concentration of immunological markers (aCCP and RF) in the blood was statistically significant only for aCCP IgG (r = –0.5, p = 0.02); no similar correlations were revealed for X-ray and US.
Conclusions: The best technique for detection of erosions, especially in the wrist region in undifferentiated polyarthritis, is MRI in comparison to X-ray and US. Positive results of aCCP3 (IgG/IgA) in undifferentiated polyarthritis are more frequent and are present in higher values than positive results of aCCP2 (IgG).
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Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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