Comment on: The use of MRI in early RA.

et al. Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis. studies to define factors that may predict the topography of periarticular erosion formation in arthritis. Arthritis Rheum. In press. 8 Sugimoto H, Takeda A, Masuyama J, Furuse M. Early-stage rheumatoid arthritis: diagnostic accuracy of MR imaging. Radiology 1996;198:185–92. 9 van Dongen H, van Aken J, Lard LR et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study. Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Comment on: The use of MRI in early RA: reply SIR, I would like to thank Prof. McGonagle and Dr Tan [1] for their interest in the recently published editorial [2]. These authors argue that MRI in early RA does not have any 'relevance' as identical features can occur in other conditions, citing their own work in PMR (currently in press). It is true that MRI cannot be used to differentiate between the inflammatory arthritides in the early phase as synovitis, tenosynovitis, bone oedema and erosions have all been described in PsA, SLE and PMR as well as RA [3–6]. However, as alluded to in the article, it is often relevant to determine whether a patient with hand or wrist pain truly has evidence of inflammation and MRI can be most informative in this respect. Ejberg et al. compared MRI scans of the wrist from normal controls with RA patients and found that moderate–high grade synovitis and bone oedema (any grade) occurred exclusively in the RA group [7]. The finding of MRI erosions on the hands or feet must surely be regarded as highly significant because it indicates the onset of joint damage. The inexorable progression of the MRI erosion score in our own RA cohort from a median of 2.0 at baseline, increasing to 9.0 at 1 yr and 21.0 at 6 yrs [8], clearly reflects the destructive potential of the disease and shows exactly the same pattern as the …