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No clear role for MRI in rheumatoid arthritis

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Current data do not support the widespread use of MRI for the diagnosis and prognosis of rheumatoid arthritis (RA), researchers conclude in a report published November 17th online in Arthritis Care & Research.

“I do not think our findings suggest MRI has no role in diagnosing or prognosticating RA, but rather that we still don’t know what that role should be – the data are insufficient as yet to define a clear role for MRI,” Dr. Lisa G. Suter from Yale School of Medicine, New Haven, Connecticut told Reuters Health in an email. “The most compelling data to date support the prognostic capability of MRI bone marrow edema to risk stratify patients at higher risk of disease progression, but more data are needed.”

Dr. Suter and colleagues systematically evaluated published reports describing the diagnostic and prognostic capability of MRI findings in patients with undifferentiated inflammatory arthritis and early RA.

Eleven diagnostic studies included 606 patients with undifferentiated inflammatory arthritis.

The sensitivity of MRI for diagnosing RA ranged widely, from 20% to 100%, as did the specificity (from 0% to 100%), even when comparable MRI definitions of RA were used.

MRI performance improved when the analysis was limited only to those studies in the highest quartile of quality or earliest disease, whereas limiting analysis to studies in the highest size quartile or to specific MRI parameters appeared to decrease MRI performance.

Seventeen studies comprising 710 patients investigated the prognostic capability of MRI.

There was marked variation in methodological quality among these studies, and only 2 of 9 that used uniform treatment over the course of the study found MRI findings to be significantly associated with subsequent radiographic progression. Only one study provided enough data to calculate sensitivity and specificity of MRI to predict radiographic erosions at 1 year.

MRI performance was slightly improved when analysis was limited to studies examining only the presence of baseline MRI erosions or patients with disease duration less than 6 months.

“Small study size, variability in methodological quality, and lack of uniform treatment limited our ability to make robust statements about the utility of MRI in clinical practice,” the researchers conclude.

“I think all clinicians struggle to balance evidence-based medicine with patient-centered medicine with the appropriate adoption of technological advances,” Dr. Suter said. “Unfortunately, these approaches do not always provide us with uniform clinical care. Our work serves to remind clinicians that while MRI is a powerful tool to enhance clinical care, its role in the day-to-day diagnosis and management of RA has yet to be defined.”

Several ongoing clinical trials aim to resolve the question of MRI’s place in the diagnosis and prognosis of RA. “I do not know exactly when clinical trial results may be available to clarify these specific questions,” DR. Suter said, “but, as more and more clinical trials include MRI results, it may be feasible to pool existing and/or ongoing trial data in the near term to help inform these issues.”

Arthritis Care & Research 17 November 2010.