Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy

Arthritis and Rheumatism
D McGonagleP Emery

Abstract

To use magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) and spondylarthropathy (SpA) to determine if the primary site of abnormality differs. Twenty patients with recent-onset knee effusion (10 with SpA and 10 with RA) were evaluated using fat-suppressed MRI. Knee joint effusion and synovitis were confirmed using ultrasonography. MRI scans were independently scored by 2 observers who were blinded to the patient's diagnosis. All 10 of the SpA patients, but only 4 of the 10 RA patients, had focal peri-entheseal high signal (compatible with fluid or edema) outside the joint (P = 0.01). Six of the SpA patients had bone marrow edema that was maximal at entheseal insertions; in 4 cases this was multifocal. No RA patients showed such an abnormality (P = 0.01). Prominent entheseal abnormalities on MRI are a consistent feature of new-onset synovitis in SpA, but are a minor feature of RA. This finding has important implications for the diagnosis, classification, and mechanisms of synovitis in patients with SpA.

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Citations

Jun 12, 1999·Arthritis and Rheumatism·D McGonagleP Emery
Aug 14, 1999·Arthritis and Rheumatism·H S El-GabalawyH R Schumacher
Feb 14, 2006·Skeletal Radiology·Adem KirisErcan Kocakoc
Dec 2, 2006·Skeletal Radiology·J M FarrantA J Grainger
Nov 9, 2006·Skeletal Radiology·J M FarrantP J O'Connor
Oct 7, 2006·Zeitschrift für Rheumatologie·J BraunR Rau
Oct 31, 2006·Zeitschrift für Rheumatologie·J Braun, J Sieper
Jun 6, 2008·Clinical Rheumatology·Ignazio OlivieriLibero Barozzi
Jun 16, 2009·Clinical Rheumatology·Giuseppe GuglielmiWalter Grassi
May 27, 2008·Wiener medizinische Wochenschrift·Christian DejacoMichael Schirmer
Nov 13, 2002·Current Rheumatology Reports·Dennis McGonaglePaul Emery
Jul 30, 2008·Current Rheumatology Reports·Fiona M McQueenAnthony Doyle
Sep 27, 2008·Current Rheumatology Reports·Heiner Appel, Joachim Sieper
Sep 29, 2001·The Israel Medical Association Journal : IMAJ·A Toivanen, P Toivanen
Sep 21, 2001·Current Rheumatology Reports·P Costello, O FitzGerald
Dec 21, 2000·Current Rheumatology Reports·J Braun, J Sieper
Feb 2, 2012·Clinical Reviews in Allergy & Immunology·Allen Anandarajah
Aug 6, 2013·Molecular Immunology·Jonathan P SherlockDaniel J Cua
Nov 3, 1998·Lancet·D McGonagleP Emery
Jul 10, 2002·Joint, Bone, Spine : Revue Du Rhumatisme·Maria Antonietta D'Agostino, Maxime Breban
Jun 6, 2003·Best Practice & Research. Clinical Rheumatology·Ai Lyn TanDennis McGonagle
Nov 27, 2007·Nature Clinical Practice. Rheumatology·Christopher Ritchlin
Sep 9, 2011·Nature Medicine·Daniel J Cua, Jonathan P Sherlock
Oct 7, 2009·Nature Reviews. Rheumatology·Allen P Anandarajah, Christopher T Ritchlin
Jul 20, 1999·Current Opinion in Rheumatology·D McGonagleP Emery
Jul 26, 2000·Current Opinion in Rheumatology·R Scarpa, A Mathieu
Sep 14, 2001·Current Opinion in Rheumatology·R J FrançoisM A Khan
Jul 16, 2002·Current Opinion in Rheumatology·Carol A Hitchon, Hani S El-Gabalawy
Jun 24, 2003·Current Opinion in Rheumatology·Xiang ZhangRobert D Inman
Jun 24, 2003·Current Opinion in Rheumatology·Juergen BraunJoachim Sieper
Apr 23, 2004·Current Opinion in Rheumatology·Mikkel Østergaard, Charlotte Wiell

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