Imaging for RA: An Overview | Arthritis Information

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Rheumatoid arthritis is an inflammatory disorder affecting multiple joints in the body. The hands and wrist, hip, knee and cervical spine are frequently involved. It is important to distinguish an inflammatory arthropathy from a degenerative process such as osteoarthritis because the clinical disease progression and, therefore, treatment are different. Imaging, especially x-ray (conventional radiograph), CT, MR, Ultrasound and Radionuclide Bone Scan, can each help confirm or exclude the diagnosis.

Specialized Diagnostic Imaging Examination

Clinical signs of rheumatoid arthritis may be evident before it is evident on conventional (routine or special) radiographic views. At Hospital for Special Surgery, MRI, CT, Ultrasound and Radionuclide Bone Scans are used in certain instances because they are more sensitive for the detection of early rheumatoid arthritis. MRI can detect early cartilage wear earlier than radiographs. Also, MRI and ultrasound can show inflammatory changes of the synovium and pannus formation.

  • MRI is very sensitive to bony and soft tissue changes. MRI can also demonstrate reactive bone edema or soft tissue swelling as well as small cartilage or bone fragments in the joint. MRI performed with appropriate dedicated protocols for the musculoskeletal system is very sensitive. At HSS, specific cartilage pulse sequences are used to identify early evidence of cartilage degeneration. When there is objective evidence of cartilage wear, appropriate treatment can be initiated to prevent or delay progression.
  • CT is excellent for demonstrating the degree of osteophyte (bone spur) formation and their relationship to the adjacent soft tissues. CT is also useful to provide guidance for therapeutic and diagnostic procedures.
  • Ultrasound is extremely sensitive for identifying synovial cysts and outpouches that can form in association with osteoarthritis. Ultrasound can also be used to image articular cartilage in patients who cannot tolerate an MRI examination and can also be used to guide for diagnostic and therapeutic procedures.
  • Radionuclide Bone Scans are very sensitive in detecting reactive bone edema association with osteoarthritis. Bone scans can also image the entire skeleton in one examination and thus can provide the clinician with helpful information in patients who there are multiple sites of arthritic involvement.

http://hss.edu/conditions_rheumatoid-arthritis-imaging-overview.asp
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