Page 41 - Imaging of Osteoarthritis and Rheumatoid Arthritis in Hand Joints

Systematic review of advanced hand OA imaging
Responsiveness
Two US and three scintigraphy studies assessed change scores over time, and included a comparator. Only two of these studies assessed true responsiveness by calculating a correlation coefficient between the changes (Table 4).
One US study reported a significant decrease in PD and effusion in patients 2 treated with intra-articular hyaluronic acid injections. These decreases
correlated with a significant reduction of pain (r=0.7 and r=0.8).44 The other US
study reported a small non-significant decrease in greyscale synovitis and PD
in patients treated with intramuscular methylprednisolone injections, while there was a significant decrease in pain.43
In the scintigraphy studies, no interventions were used, but change during disease progression was measured. In all three studies scintigraphic scores decreased over time while the disease progressed and radiographic and pain scores increased.28, 32, 50 Changes in the radiographic scores were weakly correlated with changes in the scintigraphic scores (r=0.13).32
Discussion
This systematic review shows that there is growing evidence on validity, reliability and responsiveness of advanced imaging methods in hand OA. US and MRI seem the most promising candidates, with US being the most investigated modality. Few studies have compared US directly with MRI. Wittoek et al. reported that MRI was more sensitive for synovitis and erosions, but US detected more effusion and osteophytes.53 This last finding, however, is in contrast with a recent publication by Mathiessen et al. in which osteophytes were more often detected with MRI (87% vs 75%).65 According to Mathiessen, the MRI might have underperformed in the study by Wittoek, as they did not use standardised scoring methods and had poor inter-reader reliability.
US and MRI were both more sensitive for detecting osteophytes and erosions than CR, with the exception of one US study. US and MRI also showed significant differences between patients and healthy controls for structural and soft-tissue changes, including ligament abnormalities, which were only investigated
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