Rheumatoid arthritis hand lesions assessed with outcome measures in rheumatoid arthritis clinical trials-rheumatoid arthritis magnetic resonance imaging score – proposing an extended rheumatoid arthritis magnetic resonance imaging score

Introduction: The Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) and Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS), with the EULAR-OMERACT-2005 MR-Atlas, demonstrate characteristics and lesion degrees (synovitis, erosions, bone marrow edema [BME]) in rheumatoid arthritis (R.A.) clinical diagnosis for follow-up and treatment response. Our study’s objective was to use RAMRIS in patients from three R.A. phases to detect lesions according to their tissue characterization (fluid levels in tissue) using different magnetic resonance imaging (MRI) sequences. Methods: Sixty contrast-enhanced MRIs from R.A. patients (clinical suspect arthralgia [CSA] – 38%, early R.A. [ERA] – 37%, and established [R.A.] – 25%) were evaluated according to the American College of Rheumatology (ACR-EULAR)-2010 criteria. R.A. lesions evaluation was performed with RAMRIS/Atlas/scoring; our analysis added the presence of lesions in the thumb and wrist (tenosynovitis, synovitis, erosions, and BME), proposing an “extended RAMRIS.” Results: Overall, 83% (50/60) women, mean 42 ± 13.5 (19-70) years-of-age, from 1731 evaluated sites, 964 lesions were identified. Synovitis 46% (445/964) was most frequently found in the carpal bones 72% (321/445). Extended RAMRIS demonstrated tenosynovitis and erosions in 1st carpometacarpal, 1st metacarpophalangeal, and hand-wrist tenosynovitis. Gadolinium contrast showed synovial and erosions enhancement indicating active lesions, most predominantly in ERA. Conclusions: Extended RAMRIS score was not statistically different (p = 0.43) from RAMRIS-2005. However, it considers all hand-wrist bone joint sites and tendon lesions needed for assessing a more accurate degree of disease development. A proposed extended RAMRIS should be considered.