Role of MRI in early Rhenmatoid Arthritis

Clinical History: A 53 years old male presented with over 8 months history of:

1. Pain in the both wrist joints, more marked on the right side.
2. Compromised movements of hand (more on right side) while typing,
3. driving and riding.
4. Minimal swelling seen in the right wrist joint.
5. No h/o trauma, fever noted.
6. X-Ray investigations normal.
7. Family h/o of rheumatoid arthritis noted.

Imaging Findings: Patient referred for plain MR Imaging of the wrist joint.

• Small early erosive changes were noted at the radial aspect of base of first metacarpal, in the periphery of scaphoid bone, triquetral bone and capitate bone. Few of these showed mild enhancement on post contrast scan.
• Small chondral erosion was also seen in the anterior part of the articular cartilage over the radius.
• Synovial thickening around the carpal bones.
• Fluid was noted along the flexor and extensor tendons.
• Complete tear noted in the dorsal, membranous and volar fibres of scapho-lunate ligament with scapho-lunate dissociation.
• No evidence of marrow edema noted.

Final Diagnosis: Inflammatory Arthritis- Early Rheumatoid Arthritis