Multimodality Imaging of Rheumatoid and Psoriatic Arthritis of the Hand

A review of the contemporary role of imaging in the diagnosis and treatment of the two types of inflammatory arthritis that involve the hand joints.

Course ID: Q00670 Category:
Modalities: , , ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Computed Tomography: 2.00
Procedures: 2.00
Head, Spine, and Musculoskeletal: 2.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Musculoskeletal: 2.00

Radiography: 2.00
Procedures: 2.00
Extremity Procedures: 2.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Musculoskeletal and Endocrine Sections: 2.00

Sonography: 2.00
Procedures: 2.00
Superficial Structures and Other Sonographic Procedures: 2.00


  1. Introduction
  2. Pathophysiology
  3. Synovio-Entheseal Complex
  4. Imaging Modalities
    1. Radiography
    2. Ultrasonography
    3. Magnetic Resonance Imaging
    4. CT and Dual-Energy CT
  5. Systematic Approach to Differentiate RA and PsA of the Hand: Multimodality Imaging Characteristics
    1. Alignment
    2. Bone Change: Bone Density, Erosion, and Proliferation
    3. Bone Marrow Edema
    4. Cartilage Damage
    5. Distribution
    6. Effusion with Synovitis or Enthesitis
  6. Summary of Imaging Features
  7. Conclusion


Upon completion of this course, students will:

  1. be familiar with the percentage of RA patients with negative test results for rheumatoid factor
  2. be familiar with the factors associated with the development of RA and PsA
  3. identify the most investigated cytokines in RA
  4. be familiar with the inhibitors for PsA
  5. understand the synovio-entheseal complex
  6. identify the primary imaging modality for evaluating inflammatory arthritis
  7. identify the imaging modality of choice when evaluating arthritis, even when findings at radiography are unremarkable
  8. be familiar with the limitations of using US to evaluate patients presenting with RA or PsA
  9. identify the imaging modality with higher sensitivity than radiography and US for detecting bone erosions
  10. be familiar with MRI sequences used for diagnosing inflammatory arthritis
  11. identify the imaging modality regarded as the standard examination when evaluating structural changes in patients presenting with RA or PsA
  12. be familiar with dual-energy CT processing techniques used to depict inflammatory lesions in inflammatory arthritis
  13. be familiar with the mnemonic ABCDE used when interpreting images of RA or PsA patients
  14. be familiar with the deformities most frequently found in RA patients
  15. be familiar with the swan neck deformity
  16. be familiar with the development of bone erosions within 1 year after the onset of RA
  17. be familiar with the bone formation associated with patients presenting with PsA
  18. be familiar with the pencil-in-cup deformity in patients presenting with PsA
  19. identify the MRI sequences used to assess bone marrow edema
  20. identify the mouse ear sign associated with PsA
  21. identify the pencil-in-cup deformity associated with patients presenting with PsA
  22. be familiar with the advantages of dual-energy CT for assessing bone marrow edema
  23. be familiar with the result of cartilage results on medical imaging
  24. identify the imaging modality used for evaluating joint spaces
  25. be familiar with the imaging patterns of inflammation associated with dactylitis
  26. be familiar with the imaging modalities of choice for diagnosing effusion in the joint
  27. be familiar with the use of MRI contrast when diagnosing effusion
  28. be familiar with the administration of MRI contrast when differentiating between synovium and joint fluid
  29. be familiar with the MRI sequences used to diagnose synovitis in patients with RA
  30. identify the imaging modality that allows detailed visualization of the proliferated synovium and perfusional changes induced by synovitis
  31. be familiar with the findings of Gutierrez et al
  32. be familiar with the imaging feature of tenosynovitis
  33. identify the imaging modality found to be superior in demonstrating inflammatory lesions in small joints
  34. identify the imaging modalities used for diagnosing inflammatory lesions
  35. be familiar with the findings of sacroiliitis in patients presenting with RA