Is MRI of value in the clinical setting for arthritis patients?

When treating rheumatoid arthritis (RA), rheumatologists will take into account their patients symptoms, exam, lab, and x-rays in determining the proper course of therapy. Recently some doctors have started ordering MRI scans, an expensive radiologic procedure to help in their decision making. The thought is that an MRI can detect damage before a conventional radiograph (x-ray).

An MRI might be useful in a rheumatoid patient who has a normal x-ray (i.e. no changes of rheumatoid arthritis). If one sees erosions on MRI, the doctor might consider starting more aggressive treatments such as methotrexate or TNF blockers instead of using milder drugs such as hydroxychloroquine or sulfasalazine.

On the other hand, it is quite possible that changes seen on MRI may have little clinical significance on a patients long term course. More research is definitely needed to determine the utility of using MRI in the clinical setting before recommending it for most patients with RA. Some physicians may have recently purchased or rented an MRI scanner, so if your doctor has recommended an MRI, be sure to question them on how the results of the study would change (normal or abnormal) your treatment plan.