Page 133 - Imaging of Osteoarthritis and Rheumatoid Arthritis in Hand Joints
P. 133

Osteoarthritis (OA) and rheumatoid arthritis (RA) are two prevalent joint disease of very different etiology, both affecting hand joints, and both a large cause of hand pain and hand disability in developed countries. The focus of this thesis lies on improving knowledge of radiological imaging techniques to detect features of OA and RA in hand joints.
In chapter 1, a general overview is given on osteoarthritis and rheumatoid arthritis, including the changes that happen in the joints on an anatomical level. The working mechanisms of the different radiological imaging methods are explained, as well as how these affect the imaging of hand joints with osteoarthritis and rheumatoid arthritis. The chapter ends with a discussion of the current role that imaging has in these diseases leading to the specific aims of this thesis: (I) To assess construct validity and reliability of direct cartilage imaging with MRI in hand OA; (II) to asses if CT has better reliability and detection rate of thumb base OA than conventional radiography; and (III) To assess construct validity of low-field extremity MRI in early arthritis patients.
Conventional radiography is the standard method to image hand OA. The available literature on imaging techniques other than conventional radiography for imaging hand OA was systematically reviewed in Chapter 2. Validity, reliability and responsiveness of these imaging methods were assessed. No CT studies measuring these properties for hand OA were found. The available MRI and US studies showed that they are promising candidates for early detection of hand OA and for future use in clinical trials. However, further research was still needed to improve US and MRI scoring methods, to further asses MRI reliability and to determine responsiveness of both US and MRI.
The presence of OA in the scaphotrapeziotrapezoidal (STT) joint affects the 8 surgical procedure in patients with severe OA of the first carpometacarpal
(CMC1) joint. In chapter 3, CT was compared with conventional radiography
for the detection of OA of the CMC1 and STT joint. CT had a better inter-reader
reliability and was more sensitive for detection of OA in the thumb base, especially in the STT joint. CT may therefore improve selection of treatment and planning of surgical procedures in patients with severe thumb base OA.

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