A semi-quantitative analysis of lupus arthritis using contrasted high-field MRI

Objective Arthritis in systemic lupus erythematosus is poorly described and there is no objective measure for quantification of the arthritis. We aim to develop MRI as a research tool for the quantification of lupus arthritis. Methods Patients were eligible for entry into the study if they were evaluated at the MUSC Lupus Center and determined by their treating physician to have active hand arthritis due to SLE. Standard of care lupus activity measures were collected along with a detailed physical exam. MRI images were obtained using standard musculoskeletal sequences with gadolinium contrast. Semi-quantitative scoring of the images used the OMERACT RAMRIS system. Results RAMRIS demonstrates large amounts of synovitis, tenosynovitis, bone marrow edema and erosive disease in only a minority of patients. Some patients were not scored as having any synovitis or tenosynovits. We describe potential features of lupus arthritis that are not captured in the RAMRIS scores and may be contributing to symptoms. Conclusion Lupus arthritis is an entity separate from rheumatoid arthritis and requires the development of new quantitative methods to describe it. MRI findings suggest the inadequacy of a typical lupus musculoskeletal measures and even swollen/tender joint counts to assess the level of disease activity.