Duer-Jensen A, Hørslev-Petersen K, Hetland ML et al. Arthritis Rheum 2011;63:2192–202.
Patients presenting with new onset of inflammatory joint symptoms may or may not go on to develop rheumatoid arthritis (RA). These investigators found that bone edema on magnetic resonance imaging (MRI) could help identify a subset destined to progress to RA, although overall MRI was surprisingly non-specific.
Patients at the earliest stages of rheumatoid arthritis (RA) are interesting to identify because some evidence suggests that they are especially amenable to treatment. However, among patients presenting to the clinic with arthralgia, but with examination and laboratory findings inconclusive for RA, it can be difficult to unambiguously identify those who will go on to experience self-limited disease and who would potentially benefit from early initiation of disease-modifying therapy. These authors conducted a prospective study to identify early markers of progression to RA. They enrolled 116 patients presenting to a Danish early arthritis clinic without a conclusive rheumatic diagnosis but with at least two swollen or at least two tender joints lasting between 6 weeks and 2 years; 24 healthy controls were also studied. All patients received routine laboratory testing, conventional hand and foot radiographs, and contrast-enhanced magnetic resonance imaging (MRI) of the dominant wrist and of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and metatarsophalangeal (MTP) joints. Patients were followed for ≥12 months for development of RA as per American College of Rheumatology (ACR) 1987 criteria. Among these patients, 27 (23.3%) went on to develop RA. In a univariate analysis, predictors of RA included morning stiffness >1 h, arthritis affecting the hand (wrist, MCP, or PIP joints), rheumatoid factor (RF) positivity, the presence of swollen joints (as opposed to only tender joints), MCP squeeze tenderness, elevated C-reactive protein level, and general patient- and physician-determined severity indices.