Presentation
Currently pain and soft-tissue edema of the knee.
Patient Data
A joint effusion is present. There is extensive thickening and contrast enhancement of the synovium in the joint and its recesses, extending into the gastrocnemius-semimembranosus bursa as well - features of synovitis.
Articular cartilage is markedly thinned in the medial compartment.
Recent erosions are visible in the medial tibial plateau and lateral femoral condyle, with enhancing synovium within them.
There are subchondral changes in the posterior part of the lateral femoral condyle and in the peripheral medial tibial plateau, being a predictor for future erosive changes.
Additionaly, decreased volume and slightly irregular margins of the PHMM are seen, in keeping with chronic degenerative changes associated most likely with medial compartment cartilage loss.
Case Discussion
Known case of seropositive rheumatoid arthritis (RA). This case presents typical features of RA, including synovitis, joint effusion, cartilage loss, erosions and bone marrow edema.
It is noteworthy that MRI is an excellent modality to predict the long-term outcome in patients with RA, as it detects areas of bone marrow edema. It has been shown that the marrow signal changes are a predictor for developing erosive changes in the following years, which has implications for therapy modification.
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