Page 102 - Imaging of Osteoarthritis and Rheumatoid Arthritis in Hand Joints

Chapter 6
with early inflammatory hand pain, by comparison with 1.5T conventional MRI and ultrasound. As a secondary objective we compared 0.2T MRI with US in the same patients for detection of synovitis in wrist and MCP joints and erosions in MCP joints.
Patients and Methods
Patients
We recruited consecutive patients with swollen or painful wrist or hand joints who entered the Rotterdam Early Arthritis CoHort (REACH).18 REACH is an inception cohort of patients with inflammatory joint disease in which patients enter from the general practitioner or from a rheumatology outpatient clinic at first consultation. Patients were included in REACH if they had one or more swollen joints or if they had two or more joints with pain with at least two of the following criteria suggestive of inflammatory arthritis: morning stiffness for more than 1 hour; unable to clench a fist in the morning; pain when shaking someone’s hand; pins and needles in the fingers; difficulties wearing rings or shoes; a family history of RA; or unexplained fatigue for less than 1 year. Patients were excluded from REACH if the joint complaints existed for more than twelve months, if the joint complaints were due to trauma or mechanical problems or if they were under 16 years of age.
Patients were excluded for this study if they already started a treatment with disease modifying antirheumatic drugs (DMARDs) or if they had a contra- indication to undergo contrast-enhanced MRI (e.g. pacemaker, metallic fragments in orbita, low kidney function). Patients were recruited in three hospitals situated in Rotterdam the Netherlands. Recruitment started in February 2010 at Erasmus MC, March 2011 at Maasstad hospital and April 2011 at Sint Fransiscus Gasthuis, and lasted until July 2011. The study was approved by the local ethics committee. All patients provided written informed consent prior to the investigation.
Clinical examination
In all patients joint swelling and joint tenderness was assessed by a trained research nurse. Additionally, C-reactive protein, erythrocyte sedimentation
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