Contrast-enhanced magnetic resonance imaging positively impacts the management of some patients with rheumatoid arthritis or suspected RA.
J Clin Rheumatol
; 18(1): 15-22, 2012 Jan.
Article
em En
| MEDLINE
| ID: mdl-22157267
ABSTRACT
OBJECTIVE:
Early diagnosis of rheumatoid arthritis (RA) is important given the availability of highly effective disease-modifying antirheumatic (DMARD) medications, including biologics. However, because of associated risks and cost, accurately assessing disease activity is critical. Because magnetic resonance imaging (MRI) can detect synovitis and bone marrow edema, both of which may precede erosion development, we sought to determine the impact of enhanced MRI on patient management in a group of patients referred for MRI by rheumatologists. MATERIALS ANDMETHODS:
After institutional review board approval, we evaluated all hand MRI examinations referred by the rheumatology department for synovitis evaluation between September 2007 and May 2009. The magnetic resonance images were classified as positive or negative and later reviewed by 2 musculoskeletal radiologists. A musculoskeletal radiologist and rheumatologist jointly reviewed the patients' medical records to determine the following (1) Did the MRI findings alter treatment? (2) Were the treatment alterations beneficial?RESULTS:
The study included 48 patients (39 women and 9 men) with a mean age of 51 years (range, 18-79 years). Significant management changes initially occurred in 79% (23/29) of the positive (DMARDs added in 20) and in 11% (2/19) of the negative MR examinations with average follow-up of ~300 days. Eighty percent (16/20) of the patients with DMARDs added experienced symptom improvement, none of the patients whose medications were discontinued experienced symptom relapse, and 18% (4/22) of patients without initial therapeutic changes required delayed treatment modifications.CONCLUSIONS:
Enhanced MRI significantly altered clinical management in 50% of these patients with RA or suspected RA. Therefore, when the clinical picture in a patient with RA or suspected RA is unclear, enhanced MRI can provide useful guidance for treatment modifications.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Artrite Reumatoide
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Imageamento por Ressonância Magnética
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Antirreumáticos
Tipo de estudo:
Diagnostic_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Adolescent
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Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Clin Rheumatol
Assunto da revista:
FISIOLOGIA
/
ORTOPEDIA
/
REUMATOLOGIA
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Estados Unidos
País de publicação:
EEUU
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ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
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UNITED STATES
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UNITED STATES OF AMERICA
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US
/
USA