Differentiating rheumatoid and psoriatic arthritis: a systematic analysis of high-resolution magnetic resonance imaging
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SCIENTIFIC ARTICLE
Differentiating rheumatoid and psoriatic arthritis: a systematic analysis of high-resolution magnetic resonance imaging features—preliminary findings Daniel B. Abrar 1 & Christoph Schleich 1 & Ralph Brinks 2 & Christine Goertz 2 & Matthias Schneider 2 & Sven Nebelung 1 & Philipp Sewerin 2 Received: 23 May 2020 / Revised: 7 August 2020 / Accepted: 16 August 2020 # The Author(s) 2020
Abstract Background Because of overlapping phenotypical presentations, the diagnostic differentiation of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) remains challenging. Thus, this study aimed to examine the diagnostic value of distinct imaging features obtained by high-resolution 3-T MRI for the diagnostic differentiation. Materials and methods Seventeen patients with PsA and 28 patients with RA were imaged at high resolution using 3-T MRI scanners and a dedicated 16-channel hand coil. All images were analyzed according to the outcome measures in rheumatology clinical trials’ (OMERACT) RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score) and PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Score) for the presence and intensity of synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, bone proliferation, and joint space narrowing. Next, odds ratios (OR) were calculated to determine the strength of the associations between these imaging features, demographic characteristics, and the outcome RA vs. PsA. Results PsA could be differentiated from RA by extracapsular inflammatory changes (PsAMRIS sub-score “periarticular inflammation”), with low odds for the presence of RA (OR of 0.06, p < 0.01) at all metacarpophalangeal (MCP) joints. A prediction model informed by the items that were strongest associated with the presence of RA or PsA demonstrated excellent differentiating capability with an area under the curve of 98.1%. Conclusion High-resolution imaging is beneficial for the identification of relevant imaging features that may assist the clinical differentiation of inflammatory conditions of the hand. At the MCP level, extracapsular inflammatory changes were strongly associated with PsA and may consequently allow the imaging differentiation of PsA and RA. Keywords Psoriatic arthritis . Rheumatoid arthritis . MRI . PsAMRIS . RAMRIS . Metacarpophalangeal joint
Introduction Christoph Schleich, Sven Nebelung and Philipp Sewerin contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00256-020-03588-5) contains supplementary material, which is available to authorized users. * Daniel B. Abrar [email protected] 1
Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, 40225 Dusseldorf, Germany
2
Policlinic and Hiller Research Unit of Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany
Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic inflammatory conditions th
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