Choosing To Live Better

3 Different Imaging Methods For Monitoring Disease Progression In Rheumatoid Arthritis

As a patient with rheumatoid arthritis (RA), understanding the tools available to determine disease progression can help you be more proactive with your treatment. Although some imaging tests are commonly used for RA, they do not always tell the entire story of joint destruction.


X-ray is the most commonly used form of imaging in RA, whether you are in the diagnostic phase of your disease or are monitoring disease progression. Although x-rays are fast and inexpensive, they reveal limited information about the state of your disease, but can work well as benchmark to determine the current state of your joints. Generally, a radiologist can see evidence of joint erosion or narrowing of joints spaces. Joint erosion are considered to be the hallmark of destruction in RA. Decreasing joint space usually indicates destruction of cartilage. To some degree, a radiologist may notice soft tissue swelling on an x-ray or evidence of osteopenia, which is decreased bone density that is not significant enough to be considered osteoporosis.


Ultrasound is another relatively inexpensive imaging tool, especially when compared to CT or MRI. It is also convenient because ultrasound technicians can perform the test in a clinical or outpatient setting. Ultrasound is an excellent tool to help identify soft tissue damage, which is impossible to detect with x-ray. There are many complications associated with RA that go beyond destruction of the joint surface, making other imaging tests useful. For example, joint deformities are common with RA, especially in the fingers and toes. Deformities are not caused by destruction of the joint, but are a consequence of a destroyed joint capsule and damage to supporting structures of the joint. Larger joints may not deform, but suffer similar damage to supporting structures, which eventually causes instability of the joint and dislocations.


MRI can be an especially useful tool for observing structures within the central skeleton, such as the neck and pelvis. A major concern for some people is significant pain and inflammation in the cervical vertebrae, which can lead to a potentially dangerous slip of the first and second vertebrae. MRI is especially useful for viewing the soft tissues in these areas. A radiologist may notice changes in the cervical spine that are consistent with compression, bone spurs, or subtle shifts in alignment of the vertebrae. When these issues are identified early, surgical methods may be necessary to increase the neck's stability and potentially avoid nerve damage or spinal compression. Few of these changes are easily identified with x-ray alone.

Although x-ray is a convenient and important tool for RA patients, it is insufficient to address the wide scope of a destructive disease. If you are not achieving good disease control or your x-rays do not correlate with your pain and limitations, consider asking your doctor about other imaging options, like DirectImaging .