Download PDF
Aktuelle Rheumatologie 2012; 37(02): 105-112
DOI: 10.1055/s-0032-1301929
Review
© Georg Thieme Verlag KG Stuttgart · New York

Differential Diagnosis of Rheumatoid and Psoriatic Arthritis at an Early Stage in the Small Hand and Foot Joints using Magnetic Resonance Imaging

Differenzialdiagnose zwischen Rheumatoider und Psoriasis-Arthritis im Frühstadium an den kleinen Gelenken der Hände und Vorfüsse mittels MRT
V. Jevtic
1   Department of Radiology, Faculty for Health Sciences, University of Ljubljana, Ljubljana, Slovenia
,
G. Lingg
2   Private, Bad Kreuznach, Germany, formerly Zentrales Röntgeninstitut des Sana-Rheuma-Zentrums Mainz Bad Kreuznach, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2012 (online)

Also available at
    Permissions and Reprints

Abstract

The 2 major and clinically most important primary inflammatory rheumatic diseases which affect small hand and feet joints are rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The most important initial histopathological feature of RA is synovitis followed by chronic proliferative granulomatous pannus-tissue, which is associated with cartilage and bone destruction. Early inflammatory changes in RA also develop synchronously within the subchondral bone marrow. Enthesitis is the hallmark of SNSA, and is often seen as one of the first radiological manifestations of the diseases. As a rule inflammation within the synovial joints, histologically similar to RA, is not so pronounced. Consequently destructive changes within the synovial joints are much less with the exception of PsA in which pronounced bone destruction may develop (arthritis mutilans). Considerable overlapping in clinical and morphological manifestation of RA and PsA may be present. For evaluation of hand and feet joints and surrounding soft tissue structures in RA and PsA different imaging modalities are used, which include projection radiography, ultrasonography (US), radionuclide techniques and magnetic resonance imaging (MRI). MRI has become the imaging modality of choice for evaluation of arthritis, when conventional radiography is not conclusive.

Zusammenfassung

Die beiden häufigsten und klinisch wichtigsten polyartikulär oder oligoartikulär an den kleinen Gelenken der Hände und Vorfüsse beginnenden, primär entzündlichen Erkrankungen sind die rheumatoide Arthritis (RA) und die Psoriasis-arthritis (PsA). Die wichtigsten histopathologischen Frühveränderungen sind unterschiedlich. Bei der RA umfassen sie die Synovialitis, gefolgt vom chronischen granulomatösen Entzündungsgewebe, dem Pannus, sowie sehr frühen Knorpel- und Knochendestruktionen, einschließlich subchondraler Knochendestruktionen. Bei der PsA sind frühe Enthesitiden das Hauptmerkmal der Erkrankung. Nach Diskussion der Möglichkeiten der konventionellen Röntgendiagnostik, des Ultraschalls und der Knochenszintigrafie kann gezeigt werden, dass die MRT unter Nutzung verschiedener Aufnahme-Frequenzen in der Lage ist, nicht nur Frühveränderungen der Gruppe rheumatischer Erkrankungen insgesamt bildgebend darzustellen, sondern dass sie auch bildgebend alle die RA und die PsA unterscheidenden histopathologischen Phänomene in einem Untersuchungsgang differentialdiagnostisch aufzuzeigen vermag.

Key words

rheumatoid arthritis - psoriatic arthritis - small joints of the hand and feet - differential diagnosis - magnetic resonance imaging

Schlüsselwörter

Rheumatoide Arthritis - Psoriasis-arthritis - kleine Gelenke der Hände und Vorfüsse - Differentialdiagnose - MRT
 

  • References

  • 1 Freemont AJ. The pathophysiology of cartilage and synovium. British Journal of Rheumatology 1996; 35 (Suppl. 03) 10-13
    CrossrefPubMedGoogle Scholar
  • 2 McGonagle D, Stockwin L, Isaacs J et al. An enthesitis based model for spondyloarthropahy. J Rheumatol 2001; 28: 2155-2159
    PubMedGoogle Scholar
  • 3 Poole AR. The histopathology of ankylosing spondylitis: Are there unifying hypotheses?. The American Journal of the Medical Sciences 1988; 316 (04) 228-233
    PubMedGoogle Scholar
  • 4 Jevtic V. Magnetic resonance imaging appearances of different discovertebral lesions. Eur Radiol 2001; 11: 1123-1135
    CrossrefPubMedGoogle Scholar
  • 5 Bromley M, Woolley DE. Chondroclasts and osteoclasts at subchondral sites of erosion in the rheumatoid joint. Arthritis Rheum 1984; 27: 968-975
    CrossrefPubMedGoogle Scholar
  • 6 Iwata Y, Mort JS, Tateishi H et al. Marcophage catepsin L, a factor in the erosion of subchondral bone in rheumatoid arthritis. Arthritis Rheum 1997; 40: 499-509
    CrossrefPubMedGoogle Scholar
  • 7 Bugatti S, Caporali R, Manzo A et al. Involvement of subchondral bone marrow in rheumatoid arthritis. Lymphoid neogenesis and in situ relationship to subchondral osteoclast recruitment. Arthritis Rheum 2005; 52: 3448-3459
    CrossrefPubMedGoogle Scholar
  • 8 Hirohata S, Miura Y, Tmita T et al. Enhanced expression of mRNA for nuclear factor kB1(p50) in CD34+ cells of the bone marrow in rheumatoid arthritis. Arthritis Res Ther 2006; 8: R54
    CrossrefPubMedGoogle Scholar
  • 9 McGonagle D, Conaghan PG, O’Connor P et al. The relationship between synovitis and bone changes in early untreated rheumatoid arthritis. Arthritis Rheum 1999; 42 (08) 1706-1711
    CrossrefPubMedGoogle Scholar
  • 10 McQueen FM, Benton N, Perry D et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hand and feet six years later in patients with rheumatoid arthritis. Arthritis & Rheumatism 2003; 48 (07) 1814-1827
    CrossrefPubMedGoogle Scholar
  • 11 Rufai A, Ralphs JR, Benjamin M. Structure and histopathology of the insertional region of human Achilles tendon. J Orthop Res 1995; 13: 585-593
    CrossrefPubMedGoogle Scholar
  • 12 McGonagle D, Gibbon W, O’Connor P et al. Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondyloarthropathy. Arthritis & Rheumatism 1998; 41 (04) 694-700
    CrossrefPubMedGoogle Scholar
  • 13 McGonagle D, Marzo-Ortega H, O’Connor P et al. Histological assessment of early enthesitis lesion in spondyloarthropathy. Ann Rheum Dis 2002; 61: 534-537
    CrossrefPubMedGoogle Scholar
  • 14 Jevtic V, Kos-Golja M, Rozman B et al. Marginal erosive discovertebral “Romanus” lesions in ankylosing spondylitis demonstrated by contrast enhanced Gd-DTPA magnetic resonance imaging. Skeletal Radiol 2000; 29: 27-33
    CrossrefPubMedGoogle Scholar
  • 15 Buckland-Wright JC, Lynch LA, Bird C. Microfocal techniques in quantitative radiography: measurement of cancellous bone organization. British Journal of Rheumatology 1996; 35 (Suppl. 03) 18-22
    CrossrefPubMedGoogle Scholar
  • 16 Pfeil A, Haugeberg G, Hansch A et al. Value of digital X-ray radiogrammetry in the assessment of inflammatory bone loss in rheumatoid arthritis. Arthritis Care & Research 2011; 63 (05) 666-674
    CrossrefPubMedGoogle Scholar
  • 17 Sharp JT, Lidsky MD, Collins LC et al. Methods of scoring the progression of radiological changes in rheumatoid arthritis. Arthritis Rheuma 1971; 14: 706-720
    CrossrefPubMedGoogle Scholar
  • 18 Backhaus M, Burmester GR, Sandrock D et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 2002; 61: 895-904
    CrossrefPubMedGoogle Scholar
  • 19 Kainberger F, Weideglück C, Wick M et al. Sonographische Gelenk und Weichteildiagnostik bei Rheumatoider Arthritis. Akt Rheumatol 2002; 27: 317-322
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Terslev L, Torp-Pedersen S, Savnik A et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis. Arthritis & Rheumatism 2003; 48 (09) 2434-2441
    CrossrefPubMedGoogle Scholar
  • 21 Weiner SM, Jurenz S, Uhl M et al. Ultrasonography in the assessment of peripheral joint involvement in psoriatic arthritis. Clin Rheumatol 2008; 27: 983-989
    CrossrefPubMedGoogle Scholar
  • 22 Finzel S, Ohrndorf S, Englbrecht M et al. A detailed comparative study of high – resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis & Rheumatism 2011; 63 (05) 1231-1236
    CrossrefPubMedGoogle Scholar
  • 23 De Bois MHW, Arndt JW, Van der Velde EA. Joint scintigraphy for quantification of synovitis with 99mTc-labelled human immunoglobulin G compared with late phase scintigraphy with 99mTc-labelled diphosphonate. Br J Rheumatol 1994; 33: 67-73
    CrossrefPubMedGoogle Scholar
  • 24 Schmid MR, Hodler J, Vienne P. Bone marrow abnormalities of foot and ankle: STIR imaging vesus T1W contrast – enhanced fat saturated spin-echo MR imaging. Radiology 2002; 224: 463-469
    CrossrefPubMedGoogle Scholar
  • 25 Ostergaard M, Edmonds J, McQueen F et al. An introduction to the EULAR-OMERACT rheumatoid arthritis MR reference image atlas. Ann Rheum Dis 2005; 64 (0i) 3-7
    CrossrefPubMedGoogle Scholar
  • 26 Reiser MF, Bongartz Erleman R. et al. Gadolinium – DTPA in rheumatoid arthritis and related diseases: first results with dynamic magnetic resonance imaging. Skeletal Radiol 1989; 18: 591-597
    CrossrefPubMedGoogle Scholar
  • 27 Jevtic V, Watt I, Rozman B et al. Precontrast and postcontrast (Gd-DTPA) magnetic resonance imaging (MRI) of hand joints in patients with rheumatoid arthritis. Clin Radiol 1993; 48: 176-181
    CrossrefPubMedGoogle Scholar
  • 28 Jevtic V, Watt I, Rozman B et al. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 1995; 24: 351-356
    PubMedGoogle Scholar
  • 29 Jevtic V, Watt I, Rozman B et al. Prognostic value of contrast enhanced Gd-DTPA MRI for development of bone erosive changes in rheumatoid arthritis. British Journal of Rheumatology 1996; 35 (Suppl. 03) 26-30
    CrossrefPubMedGoogle Scholar
  • 30 Tamai M, Kawakami A, Takao S et al. Bone marrow edema determined by MRI reflects severe disease status in patients with early-stage rheumatoid arthritis. Ann Rheum Dis 2006; 65 (ii) 629
    CrossrefPubMedGoogle Scholar
  • 31 Torre Alonso JC, Rodrigues PA, Arribas Castrillo JM. Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients. Br J Rheumatol 1991; 30: 245-250
    CrossrefPubMedGoogle Scholar
  • 32 Moll JMH, Wright V. Psoriatic arthritis. Semin Arthritis Rheum 1973; 3: 55-78
    CrossrefPubMedGoogle Scholar
  • 33 Gladman DD. Criteria for psoriatic arthritis. Baillieres Clin Rheumatol. 9: 319
    PubMedGoogle Scholar
  • 34 Veale D, Rogers S, Fitzgerald O. Classification of clinical subsets in psoriatic arthritis. British Journal of Rheumatology 1994; 33: 133-138
    CrossrefPubMedGoogle Scholar
  • 35 Lingg G, Jevtic V, Schacherl M. Bildgebende Verfahren bei der Arthritis psoriatica. Akt Rheumatol 2000; 25: 123-131
    Google Scholar
  • 36 Giovanoni A, Grassi W, Terilli F et al. MRI of the hand in psoriatic and rheumatoid arthritis. Eur Radiol 1995; 5: 590-595
    PubMedGoogle Scholar
  • 37 Jevtic V, Kos-Golja M. Distribution of inflammatory changes of the small joints of the hand and foot in psoriatic arthritis: MRI findings. European Radiology 2000; 10 (01) B10
    PubMedGoogle Scholar
  • 38 Jevtic V, Rozman B, Kos-Golja M et al. Precontrast and postcontrast (Gd-DTPA) MR imaging of hand joints in patients with rheumatoid and psoriatic arthritis. Farm Vestn 1990; 41: 322-326
    PubMedGoogle Scholar
  • 39 Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference film. Acta Radiol (Diagn) 1977; 18: 481-491
    Google Scholar
  • 40 Backhaus M, Kamradt T, Sandrock D et al. Arthritis of the finger joints. Arthritis & Rheumatism 1999; 42 (06) 1232-1245
    CrossrefPubMedGoogle Scholar
  • 41 Ghanem N, Uhl M, Pache G et al. MRI in psoriatic arthritis with hand and foot involvement. Rheumatol Int 2007; 27: 387-393
    CrossrefPubMedGoogle Scholar
  • 42 Tehranzadeh J, Ashikyan O, Anavim A et al. Detailed analysis of contrast – enhanced MRI of hands and wrists in patients with psoriatic arthritis. Skeletal Radiol 2008; 37: 433-442
    CrossrefPubMedGoogle Scholar
  • 43 Wiell C, Szkudlarek M, Hasselquist M et al. Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis. Arthritis Research & Therapy 2007; 9 () 1-13
    PubMedGoogle Scholar