Foot MRI Unnecessary for Predicting RA in Clinically Suspect Arthralgia

hand MRI
hand MRI
Although MRI-detected tenosynovitis was associated with inflammatory arthritis development, the addition of foot MRI to hand MRI did not increase the predictive accuracy.

Magnetic resonance imaging (MRI) of the foot, complementary to the hands, did not improve the predictive accuracy of the technique to detect rheumatoid arthritis (RA) in patients with clinically suspect arthralgia, according to study results published in Rheumatology.

Researchers conducted a population-based inception cohort study of 357 patients with clinically suspect arthralgia. At baseline, study patients underwent scanning and evaluation for osteitis, tenosynovitis, and synovitis with contrast-enhanced 1.5 T-MRI of the hand (metacarpophalangeal joints 2-5), wrist, and foot (metacarpophalangeal joints 1-5) joints. During follow-up of ≥1 year, patients underwent physical examination by a rheumatologist to assess for development of inflammatory arthritis. Based on the 2010 criteria, the team also conducted sensitivity analyses using RA development as the outcome.

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After analysis, the researchers found that MRI-identified tenosynovitis of the foot joints was associated with a higher risk for RA formation in patients with clinically suspect arthralgia, independent of C-reactive protein and anti-citrullinated protein antibody levels (hazard ratio, 3.14; 95% CI, 1.48-6.64; P =.003), in addition to osteitis and synovitis (hazard ratio, 4.75; 95% CI, 2.38-9.49; P <.001).

Furthermore, performing an MRI of the feet, complementary to the hands, did not improve the predictive accuracy of the imaging technique. The team also reported that the sensitivity analyses showed similar findings.

“Foot MRI can be omitted to reduce scan time and costs and increase the feasibility,” the researchers wrote.


Boer AC, Wouters F, Dakkak YJ, Niemantsverdriet E, van der Helm-van Mil AHM. Improving the feasibility of MRI in clinically suspect arthralgia for prediction of rheumatoid arthritis by omitting scanning of the feet [published online September 30, 2019]. Rheumatology. doi:10.1093/rheumatology/kez436