J Korean Orthop Assoc.  2018 Dec;53(6):540-546. 10.4055/jkoa.2018.53.6.540.

Multimodal Diagnostic Approach for Synovitis of the Wrist

• Bae KJ
• Kim J
• Yoon C
• Hong SH
• Gong HS
• Baek GH

• KMID: 2430061
• DOI: http://doi.org/10.4055/jkoa.2018.53.6.540

Abstract

PURPOSE
The purpose of this study was to suggest a multimodal diagnostic approach to determine the cause of the disease in patients diagnosed with synovitis of the wrist and who underwent synovectomy.
MATERIALS AND METHODS
Twenty-nine patients, who underwent contrast magnetic resonance imaging (MRI) preoperatively and synovectomy from January 2000 to December 2013, were reviewed retrospectively. Among them, 17 patients underwent a Tc99m white blood cell (WBC) scan preoperatively. In patients who met the diagnostic criteria of rheumatoid arthritis (RA), the diagnosis was confirmed as RA if the MRI finding or histology was compatible with RA. If the MRI finding and histology were disparate, the final diagnosis was made based on the histologic finding.
RESULTS
Of the nine patients who met the diagnostic criteria of RA, seven patients were finally diagnosed as RA and two patients as tuberculous arthritis. Of the 20 patients who did not meet the diagnostic criteria of RA, the MRI findings and histology were consistent with the same disease in 12 patients. In the remaining eight patients, five were diagnosed with nonspecific chronic synovitis, one with RA, and two with tuberculous arthritis based on the clinical findings, MRI, and histology findings.
CONCLUSION
MRI and a WBC scan are very useful imaging modalities for diagnosing the causative condition of the wrist synovitis. A histology evaluation after synovectomy can also be useful in cases with a difficult diagnosis or are refractory to medications.

Keyword

nonspecific chronic synovitis; rheumatoid arthritis; synovitis; tuberculous arthritis; wrist

MeSH Terms

Arthritis
Arthritis, Rheumatoid
Diagnosis
Humans
Leukocytes
Magnetic Resonance Imaging
Retrospective Studies
Synovitis*
Wrist*

Figure

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  Figure 1 MRI and pathology findings of nine patients who met the diagnostic criteria of rheumatoid arthritis. MRI, magnetic resonance imaging; RA, rheumatoid arthritis; TbA, tuberculosis arthritis; NCS, nerve conduction studies.

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  Figure 2 MRI and pathology findings of 20 patients who did not meet the diagnostic criteria of the rheumatoid arthritis. MRI, magnetic resonance imaging; RA, rheumatoid arthritis; TbA, tuberculosis arthritis; NCS, nerve conduction studies.

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