MRI-detected erosions as defined by the RAMRIS criteria [24] can be observed in the metacarpophalangeal and metatarsophalangeal joints of symptom-free individuals in the general population and in different types of rheumatologic diseases and are thus nonspecific [25]. US Area of Interest As mentioned before, the 2013 EULAR task force recommendations on use of imaging of the joints in RA state that when there is diagnostic doubt following radiographs, US, or MRI can be used to improve the certainty of diagnosis of RA above clinical criteria as well as to detect early joint damage before it is radiographically visible [13]. Although MRI with IV contrast has been shown to be more sensitive compared with US and has higher diagnostic performance [21], both outperform clinical evaluation and provide prognostic information concerning Chronic Extremity Joint Pain radiographic progression [10-12]. The evidence is inconclusive as to whether MRI or US should be considered the preferred method for evaluation of RA [18]. US has been used to evaluate for osseous abnormalities in the setting of chronic inflammatory arthritis. Compared with radiography, US has been shown to demonstrate a 6.5-fold increase in the number of detected erosions of the metacarpophalangeal joints [12], but it is less accurate when compared with CT [11]. The false-positive rate for US in detection of metacarpophalangeal joint erosions has been reported as high as 29% [29]. Regardless, large erosions identified with US at the second and third metacarpophalangeal joints, the distal ulna, and the fifth metatarsophalangeal joint are highly specific for and predictive of RA [30]. US may also show imaging findings associated with enthesitis [25], with findings of enthesitis on power Doppler imaging having an accuracy of 85.6% in distinguishing peripheral spondyloarthritis versus nonspondyloarthropathy [31].
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. MRI-detected erosions as defined by the RAMRIS criteria [24] can be observed in the metacarpophalangeal and metatarsophalangeal joints of symptom-free individuals in the general population and in different types of rheumatologic diseases and are thus nonspecific [25]. US Area of Interest As mentioned before, the 2013 EULAR task force recommendations on use of imaging of the joints in RA state that when there is diagnostic doubt following radiographs, US, or MRI can be used to improve the certainty of diagnosis of RA above clinical criteria as well as to detect early joint damage before it is radiographically visible [13]. Although MRI with IV contrast has been shown to be more sensitive compared with US and has higher diagnostic performance [21], both outperform clinical evaluation and provide prognostic information concerning Chronic Extremity Joint Pain radiographic progression [10-12]. The evidence is inconclusive as to whether MRI or US should be considered the preferred method for evaluation of RA [18]. US has been used to evaluate for osseous abnormalities in the setting of chronic inflammatory arthritis. Compared with radiography, US has been shown to demonstrate a 6.5-fold increase in the number of detected erosions of the metacarpophalangeal joints [12], but it is less accurate when compared with CT [11]. The false-positive rate for US in detection of metacarpophalangeal joint erosions has been reported as high as 29% [29]. Regardless, large erosions identified with US at the second and third metacarpophalangeal joints, the distal ulna, and the fifth metatarsophalangeal joint are highly specific for and predictive of RA [30]. US may also show imaging findings associated with enthesitis [25], with findings of enthesitis on power Doppler imaging having an accuracy of 85.6% in distinguishing peripheral spondyloarthritis versus nonspondyloarthropathy [31].