|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 3 | Page : 177
Comments on: Role of magnetic resonance imaging in evaluation of asymmetric undifferentiated hand arthritis
Department of Medicine, The Sarvajanik Medical Trust Hospital, Rampura, Chhada-ole, Surat, Gujarat, India
|Date of Web Publication||11-Aug-2016|
Dr. Ankur Dalal
The Sarvajanik Medical Trust Hospital, Rampura, Chhada-ole, Surat - 395 003, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dalal A. Comments on: Role of magnetic resonance imaging in evaluation of asymmetric undifferentiated hand arthritis. Indian J Rheumatol 2016;11:177
I have read the article titled, "Role of magnetic resonance imaging (MRI) in the evaluation of asymmetric undifferentiated hand arthritis" written by Paruchuri et al.  with great interest. The authors suggest that the addition of MR-based joint area involvement (clinically normal) may enhance the performance of the American College of Rheumatology/European League against Rheumatism (ACR/EULAR) 2010 rheumatoid arthritis (RA) criteria. The recommendation is interesting, but still I would like to take an opportunity to comment one or two points here.
First of all, the ACR/EULAR 2010 criteria is a tool that aids in classifying patients as RA, thus enabling early initiation of disease-modifying antirheumatic drug (DMARD) therapy.  If a patient is not fulfilling the criteria which mean that score is < 6, he/she will be classified as having undifferentiated arthritis (UA). In such scenario, we can more accurately predict the outcome of initial UA by integrating clinical and laboratory findings within the Leiden early arthritis clinic rule at the bedside. Low scores can be used to identify patients at very low risk of progression, and they can be spared from DMARD (immunosuppressive) therapy while higher scores identify patients who are very likely to require DMARD therapy. , This was not observed by Paruchuri et al.; means while revising initial diagnosis of UA to MRI_RA or MRI_PRA how many patients were in the group of the high risk of progression as per Leiden early arthritis clinic rule requiring DMARDs, which was the ultimate goal of the study. I felt that this will be more informative.
Second, similar to other imaging methods such as radiography, CT, and MRI, ultrasound (US) also has a role in the diagnosis of musculoskeletal disorders. Moreover, Musculoskeletal (MSK) US is estimated to be less expensive, more patient friendly, being a dynamic study and having portability than MRI.  Hence, if the same group of patients was also evaluated with MSK US and then results were compared with MRI, it will be more informative because in developing country like India MRI is still not easily and economically available.
In conclusion; though the suggestion made by Paruchuri et al are interesting, if they had also compared their findings with a clinical tool and MSK US as I have discussed above then the conclusion made by them would have been more worthwhile for clinical practice.
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Conflicts of interest
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| References|| |
Paruchuri RK, Rajasekhar L, Ressdy VS. Role of MRI in evaluation of asymmetric undifferentiated hand arthritis. Ind J Rheumatol 2016;11:60-61.
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3 rd
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2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62:2569-81.
van der Helm-van Mil AH, le Cessie S, van Dongen H, Breedveld FC, Toes RE, Huizinga TW. A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: How to guide individual treatment decisions. Arthritis Rheum 2007;56:433-40.
Pile K. Treatment of early undifferentiated arthritis. Indian J Rheumatol 2012;7:215-20.
Lento PH, Primack S. Advances and utility of diagnostic ultrasound in musculoskeletal medicine. Curr Rev Musculoskelet Med 2008;1:24-31.