Abnormal synovial vascularization can be visualized by MR angiography (MRA) as early as 6 weeks after the start of inflammatory hand symptoms. Evidence of early synovial neovascularization may be a biomarker for aggressive rheumatoid arthritis (RA).
Vasanth and associates tested the ability of MRA to identify signs of angiogenesis in 30 patients with signs and symptoms of inflammatory hand arthritis. Study participants met at least 3 of the 7 American College of Rheumatology criteria for RA. The extent of disease was evaluated by clinical and laboratory assessments, Doppler ultrasonography, and MRI/MRA; MRA was used to quantitate abnormal vessels in the wrist and metacarpophalangeal (MCP) joints.
About two-thirds of the patients had abnormal MRA scan results in the MCP joint or wrist. The number of abnormal vessels (average, 5) seen on MRA correlated strongly with the degree of blood flow, MCP joint and wrist synovitis scores, and bone edema and bone erosion scores at the wrist.
The authors noted that large prospective studies are needed to determine whether abnormal neovascularization, as measured by MRA, predicts severity of disease course or response to treatment and that if it does, treatment could be provided when disease activity is still at the synovial level.
