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MR imaging of atlantoaxial joint in early rheumatoid arthritis

Studio RM dell’articolazione atlo-assiale nella early arthritis reumatoide

La radiologia medica volume 115, pages 1111–1120 (2010)Cite this article

Abstract

Purpose

This study was done to assess the involvement of the atlantoaxial joint in patients with early rheumatoid arthritis and evaluate the role of magnetic resonance (MR) imaging in depicting this early joint involvement.

Materials and methods

Twenty patients (16 women and four men, mean age 55.0±12.9 years) with clinical and laboratory evidence of early rheumatoid arthritis (mean disease duration <12 months) were included in our study. MR imaging of the atlantoaxial joint was performed in all patients within 3 months from diagnosis. The MR features were correlated with clinical and biochemical variables.

Results

Five (25.0%) of the 20 patients exhibited enhancement of the periodontoid synovial spaces after gadolinium administration due to inflammatory synovitis. Compared with patients without cervical involvement, these five patients showed significantly higher values of erythrocyte sedimentation rate [median 77.0 mm/h (range 25th and 75th percentile 69.0–86.0) vs median 33.0 mm/h (range 25th and 75th percentile: 9.2–52) (p=0.007)]; significantly higher C-reactive protein values [median 53.6 mg/l (range 25th and 75th percentile 21.9–81.9) vs median 14.0 mg/l (range 25th and 75th percentile 0.8–20) (p=0.03)]; higher disease activity score [median 4.2 (range 25th and 75th percentile 3.9–5.4) vs median 3.2 (range 25th and 75th percentile 2.8–3.8) (p=0.03)]. Four (80%) of these five patients presented anti-citrulline antibodies (anti-CCP) and rheumatoid factor at laboratory testing. The latter was positive in 12 of the 20 patients (66%), and anti-CCP were positive in 15 (83%).

Conclusions

MR imaging showed an atlantoaxial inflammatory synovitis in 25% of patients with early rheumatoid arthritis. Our results indicate that patients with higher disease activity are likely to be at higher risk of presenting early involvement of the atlantoaxial joint. MR imaging of the cervical spine is an excellent tool for assessing the early manifestations of rheumatoid arthritis before any destructive changes occur. Therefore, MR imaging should be included in the diagnostic workup in order to provide reliable guidance for treatment choices.

Riassunto

Obiettivo

Scopo del nostro lavoro è valutare il coinvolgimento dell’articolazione atlo-assiale nei pazienti con early arthritis reumatoide (durata di malattia<12 mesi) e il ruolo della risonanza magnetica (RM) nell’evidenziare tale coinvolgimento articolare in fasi precoci della malattia.

Materiali e metodi

In questo studio, sono stato inclusi 20 pazienti (16 donne e 4 uomini; età media, 55,0±12,9 anni) con diagnosi clinica e di laboratorio di early arthritis reumatoide. Tutti i pazienti sono stati sottoposti a studio RM dell’articolazione atlo-assiale entro 3 mesi dalla diagnosi. I reperti RM sono stati correlati ai dati clinici e biochimici.

Risultati

In cinque (25,0%) dei 20 pazienti esaminati, è stato riscontrato enhancement dei recessi dell’articolazione atlo-assiale da sinovite attiva; rispetto ai pazienti con esame RM negativo, è stato inoltre riscontrato: una velocità di eritrosedimentazione significativamente più elevata all’esordio [mediana: 77,0 mm/h (range 25 e 75 percentile: 69,0–86,0) vs mediana: 33,0 mm/h (range 25 e 75 percentile: 9,2–52) (p=0,007)]; livelli di proteina C reattiva (PCR) più elevati [mediana: 53,6 mg/, (range 25 e 75 percentile: 21,9–81,9) vs mediana: 14,0 mg/l (range 25 e 75 percentile: 0,8–20) (p=0,03)]; un disease activity score (DAS 44) più elevato [mediana: 4,2, (range 25 e 75 percentile: 3,9–5,4) vs mediana: 3,2 (range 25 e 75 percentile: 2,8–3,8) (p=0,03)]. Quattro di questi cinque pazienti (80%) sono risultati positivi agli anticorpi anti-citrullina (anti-CCP) ed al fattore reumatoide. Quest’ultimo è risultato positivo in 12 dei 20 pazienti (66%) e gli anticorpi anti-CCP in 15 (83%).

Conclusioni

L’esame RM ha dimostrato una sinovite attiva atlo-assiale nel 25,0% dei pazienti con early arthritis reumatoide. I nostri risultati suggeriscono che pazienti con un’elevata attività di malattia sono a rischio di avere un interessamento dell’articolazione atlo-assiale fin dall’esordio. La RM del rachide cervicale è un eccellente metodo per dimostrare le manifestazioni precoci dell’artrite reumatoide, prima dell’insorgenza delle lesioni destruenti. Pertanto, la RM del rachide cervicale dovrebbe essere inclusa nel work-up diagnostico anche per guidare le scelte terapeutiche.

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Affiliations

  1. Department of Bioimaging and Radiological Sciences, Catholic University, School of Medicine, Largo A. Gemelli 1, Rome, Italy

    N. Magarelli, F. Simone, R. Amelia, A. Leone & L. Bonomo

  2. Department of Rheumatology, Catholic University, School of Medicine, Largo A. Gemelli 1, Rome, Italy

    S. Bosello, G. D’Antona, A. Zoli & G. Ferraccioli

Authors
  1. N. Magarelli
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  2. F. Simone
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  3. R. Amelia
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  4. A. Leone
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  5. S. Bosello
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  6. G. D’Antona
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  7. A. Zoli
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  8. G. Ferraccioli
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  9. L. Bonomo
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Correspondence to N. Magarelli.

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Magarelli, N., Simone, F., Amelia, R. et al. MR imaging of atlantoaxial joint in early rheumatoid arthritis. Radiol med 115, 1111–1120 (2010). https://doi.org/10.1007/s11547-010-0574-4

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  • DOI: https://doi.org/10.1007/s11547-010-0574-4

Keywords

  • Spine
  • Atlo-axial joint
  • MR imaging
  • Rhaumatoid arthritis

Parole chiave

  • Rachide
  • Articolazione atlo-assiale
  • Studio RM
  • Artrite reumatoide