The use of MRI in early RA

Abstract

MRI is becoming an integral part of the rheumatologist's toolkit, both for assisting in the diagnosis of RA and for monitoring disease progression and the response to therapy. However, as is the case for all imaging and indeed investigations in general, it has its limitations and there are pitfalls for the unwary. While many rheumatologists are happy to liase with radiologists and seek their advice for the interpretation of scan results, there is now much information regarding the clinical significance of MRI findings that is primarily in the rheumatology literature (with which many radiologists are unfamiliar), making it increasingly important for clinicians to have at least a summary knowledge of these advances. New developments in imaging have entered the clinical arena at just the same time as advances in therapeutics and the strategy for effectively managing RA is changing rapidly, with the emphasis now on the very early use of disease-suppressing therapy with agents including biological DMARDs (bDMARDs), aiming to completely suppress erosions and joint damage. The expense and occasional risk associated with this strategy means that diagnostic accuracy is even more important than previously, as is tailoring high-cost therapies to those most at risk for aggressive disease. MRI can be most helpful as an addition to conventional radiography, to assist the clinician in achieving optimal management for the individual patient.