FORT LAUDERDALE, FLA. — The use of magnetic resonance imaging has provided a keyhole view into the early pathological events of rheumatoid arthritis, long before structural damage becomes evident on conventional radiography, according to recent research.
MRI has yet to be as fully embraced by rheumatologists as it has been in other specialties, according to Dr. Norman B. Gaylis. “I believe that we are going to catch up, however, and our approach to management of rheumatoid arthritis will be more like that used for other systemic diseases such as lymphoma,” Dr. Gaylis said at a meeting sponsored by RHEUMATOLOGY NEWS and Skin Disease Education Foundation.
Conventional radiography cannot visualize bone marrow edema in rheumatoid arthritis (RA). “Bone marrow edema may be the best biomarker that we haven't been using in the management of rheumatoid arthritis,” said Dr. Gaylis, who is in private practice in Aventura, Fla.
Bone marrow edema in RA was first recognized in a cohort of patients from New Zealand who had MRI scans of the wrist at the time of diagnosis (Ann. Rheum. Dis. 1998;57:350–6).
The lymphocyte and osteoclast infiltration in the subchondral bone seen in bone marrow edema suggests that this might be the site for important pathological events driving the rheumatologic joint damage in RA.
Bone marrow edema also is more predictive of later MRI-detected erosions than is any other clinical feature, including disease activity score, C-reactive protein, or anticyclic citrullinated peptide antibody, and it predicts functional disability at 6 years more closely than does other MRI features such as synovitis and tendinitis (Ann. Rheum. Dis. 2004;63:555–61).
Dr. Gaylis stated that he had no conflicts of interest. SDEF and this news organization are owned by Elsevier.
To view a video interview of Dr. Gaylis, go to http://www.youtube.com/watch?v=IObehXizRQg
Bone marrow edema on MRI predicts both joint damage and disability better than clinical features. DR. GAYLIS