Forefeet MRI Validity Insufficient in Rheumatoid Arthritis

foot MRI
foot MRI
In the assessment of joint inflammation and structural damage in rheumatoid arthritis (RA), researchers determined that data did not support applying the RA MRI scoring system to the metatarsophalangeal joints as a valid outcome measure.

According to the Outcomes in Rheumatology Clinical Trials (OMERACT) Filter of Truth, Discrimination, and Feasibility, the validity of rheumatoid arthritis magnetic resonance imaging (MRI) score (RAMRIS) for forefeet is insufficient. The OMERACT RAMRIS Working Group determined a research agenda based on these results, which were published in RMD Open.

To test RAMRIS against the OMERACT Filter, the researchers performed a systematic literature review. They included studies reporting on RAMRIS applied to MRI of the metatarsophalangeal (MTP) joints in RA from medical literature databases up to January 2018.

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Studies had to include at least 1 MRI feature (synovitis, bone marrow edema, tenosynovitis, erosion, joint space narrowing) and 1 item from the OMERACT Filter: truth (face, content, and construct validity), Discrimination (test-retest reliability, ability to discriminate in trials, longitudinal construct validity, and thresholds of meaning) and Feasibility. In total, the researchers included 13 studies. Of these, 9 had data on construct validity, 4 had data on discrimination, and 1 had data on feasibility.

The study results indicated that RAMRIS may have construct validity for bone marrow edema and erosions. However, the researchers found a lack of validity for synovitis, tenosynovitis, and joint space narrowing.

The researchers proposed a research agenda to validate MRI for the forefeet. This agenda included the following:

  • Evaluating whether MRI of the MTP joints is superior to MRI of the metacarpophalangeal joints and wrists for predicting radiographic and/or functional outcomes
  • Evaluating whether MRI of the MTP joints adds additional value for predicting radiographic and/or functional outcomes
  • Assess the validity in early RA compared with established RA

“Awareness of the gaps in the OMERACT Filter criteria prior to including MRI of the MTP-joints in the RAMRIS and its implementation in trials is essential for optimal interpretation of results obtained,” the researchers wrote.


Dakkak YJ, van der Heijde DM, Reijnierse M, van der Helm-van Mil AHM. Validity of the rheumatoid arthritis MRI score applied to the forefeet using the OMERACT filter: a systematic literature review. RMD Open. 2018;4(2):e000796.