The value of MRI examination on bilateral hands including proximal interphalangeal joints for disease assessment in patients with early rheumatoid arthritis: a cross-sectional cohort study.

BACKGROUND: Bilateral hands including proximal interphalangeal joints (PIPJs) are recommended on physical, X-ray radiographic, or ultrasonographic examination by clinical guidelines of rheumatoid arthritis (RA), but MRI still tends to examine unilateral wrists and/or MCPJs. We aimed to demonstrate the advantages of MRI examination on bilateral hands including PIPJs for disease assessment in early RA patients. METHODS: Active early RA patients received 3.0T whole-body MRI examination with contrast-enhanced imaging on bilateral wrists, MCPJs, and PIPJs. MRI features were scored referring to the updated RAMRIS. Clinical assessments were conducted on the day of MRI examination. RESULTS: The mean time of MRI examination was 24 ± 3 min. MRI bone erosion in MCPJs would be missed-diagnosed in 23% of patients if non-dominant MCPJs were scanned unilaterally, while osteitis in MCPJs would be missed-diagnosed in 16% of patients if dominant MCPJs were scanned unilaterally. MRI synovitis severity was also asymmetric: 21% of patients showing severe synovitis unilaterally in non-dominant MCPJs/PIPJs and other 20% showing severe synovitis unilaterally in dominant MCPJs/PIPJs. Among these early RA patients, MRI tenosynovitis occurred the most frequently in wrist extensor compartment I, while MRI examination on bilateral hands demonstrated no overuse influence present. However, overuse should be considered in dominant PIPJ2, PIPJ4, and IPJ of thumb of which MRI tenosynovitis prevalence was respectively 18%, 17%, or 16% higher than the non-dominant counterparts. Early MRI abnormality of nervus medianus secondary to severe tenosynovitis occurred either in dominant or non-dominant wrists; MRI of unilateral hands would take a risk of missed-diagnosis. Common MRI findings in PIPJs were synovitis and tenosynovitis, respectively in 87% and 69% of patients. MRI tenosynovitis prevalence in IPJ of thumb or PIPJ5 was much higher than the continued wrist flexor compartments. MRI synovitis or tenosynovitis in PIPJs independently increased more than twice probability of joint tenderness (OR = 2.09 or 2.83, both p < 0.001). CONCLUSIONS: In consideration of asymmetric MRI features in early RA, potential overuse influence for certain tenosynovitis in dominant hands, and high prevalence of MRI findings in PIPJs, MRI examination on bilateral hands including PIPJs is deserved for disease assessment in early RA patients.

[Value of serum matrix metalloproteinase-3 in the assessment of active disease in patients with rheumatoid arthritis].

OBJECTIVE: To investigate the value of serum matrix metalloproteinase-3 (sMMP-3) in the assessment of active disease in patients with rheumatoid arthritis (RA). METHODS: One hundred and ninety-one RA patients were recruited from the Department of Rheumatology of Sun Yat-sen Memorial Hospital from June 2010 to June 2014. sMMP-3 level of these RA patients and 58 healthy people was tested by enzyme-linked immunosorbent assay, while clinical data was collected simultaneously. Receiver operating characteristic (ROC) curve was used for the analysis of optimal cut-off point for the evaluation of disease activity. RESULTS: There were 128 female patients and 63 male patients recruited. sMMP-3 was significantly higher in RA patients than healthy control and it was higher in patients with active disease than that in patients in remission (all P < 0.01). ROC curve analysis showed that the optimal cut-off point for diagnosing active RA was 84 µg/L with area under the curve (AUC) 0.822 in female and 168 µg/L with AUC 0.824 in male (both P < 0.01). According to the optimal cut-off points, the sensitivity of sMMP-3 + CRP combined detection was 97.2% for diagnosing active RA, which was significantly higher than that of sMMP-3 (84.7%) or C-reactive protein (CRP) (88.2%, both P < 0.05). The specificity of combined detection was 95.7%, which was significantly higher than that of sMMP-3 (68.1% , P < 0.01). And Youden's index of combined detection (0.951) was significantly higher than that of sMMP-3 (0.528) or CRP (0.754, both P < 0.05). CONCLUSION: sMMP-3 is a helpful indicator for disease activity measurement in RA patients. Combined detection of sMMP-3 and CRP can improve the accuracy of disease activity assessment.