Page 27 - Imaging of Osteoarthritis and Rheumatoid Arthritis in Hand Joints

Systematic review of advanced hand OA imaging
Background
Hand osteoarthritis (OA) is a disabling disease, with prevalence of up to 70%
among the elderly.1, 2 Patients typically present with intermittent joint pain and
stiffness,3 loss of joint mobility, and loss of grip strength causing impairment in 2 daily activities.4-6 Hand OA is characterised by degradation of articular cartilage,
synovial inflammation, and bone deformation. Possible treatments are limited,
but new pharmacological treatments are being developed.7
Conventional radiography (CR) is the standard imaging method for assessing structural changes in OA.8, 9 It can display joint space narrowing (JSN), an indirect measurement of cartilage destruction, and bone deformation. Although four major scoring systems are available for evaluating hand OA on CR,10- 13 there is no consensus on the optimal system. These scoring systems have demonstrated good reliability,14, 15 but low sensitivity to change within one year.14 CR does not show inflammation and seems unable to show beginning cartilage degradation.16 CR is therefore not optimal for identifying early OA or for monitoring disease progression for time periods of <1 year.17
Several other imaging techniques can be considered for detecting and monitoring OA related changes, each with their own advantages and disadvantages. These include Computed Tomography (CT), ultrasonography (US), Magnetic Resonance Imaging (MRI), and nuclear imaging methods like Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT) and scintigraphy. CT is the best method for imaging structural bony changes, but cannot depict cartilage or the joint capsule. US can visualise cartilage and other soft tissues, but the ultrasonic waves may be blocked by bony structures, hindering imaging of the whole joint. MRI visualises both bone and the soft tissues, but has a lower resolution than other imaging techniques, is time consuming and relatively expensive. Nuclear imaging methods do not visualise structural anatomy, but show metabolic activity within the joints, which can often be detected before radiographic changes.
To assess the value of advanced imaging techniques for detection of hand OA detection and its progression, we performed a systematic review of the literature to assess validity, reliability and responsiveness for CT, US, MRI, PET, SPECT and scintigraphy.
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