ARTHRITIS & RHEUMATISM Vol. 50, No. 5, May 2004, pp 1383–1389 DOI 10.1002/art.20165 © 2004, American College of Rheumatology Documenting Damage Progression in a Two-Year Longitudinal Study of Rheumatoid Arthritis Patients With Established Disease (the DAMAGE Study Cohort) Is There an Advantage in the Use of Magnetic Resonance Imaging as Compared With Plain Radiography? Paul Bird, 1 Bruce Kirkham, 2 Ian Portek, 3 Ron Shnier, 3 Fredrick Joshua, 3 John Edmonds, 1 and Marissa Lassere 1 Objective. In early rheumatoid arthritis (RA), longitudinal studies have demonstrated that magnetic resonance imaging (MRI) is more sensitive than radi- ography in demonstrating progressive erosive joint damage. The present study evaluated the progression of erosive damage in patients with established RA by using limited field of view MRI and comparing the results with those obtained by radiography. Methods. MRI and radiographic studies were available from 47 of 60 patients enrolled in a 2-year RA observational study. MRI of the metacarpophalangeal (MCP) joints was performed at baseline and 2 years later, and a single observer scored all of the MR images with the use of an MRI scoring method developed by the Outcome Measures in Rheumatology Clinical Trials MRI RA study group. MR images from 14 patients were reread by the same observer after 1 week to assess intraobserver reliability. Radiographs were obtained at baseline and at 2 years, and were scored by an observer using the Scott modification of the Larsen score. Radio- graphs from 14 patients were reread after 1 week to assess the intraobserver reliability. The smallest detect- able difference (SDD) was calculated for the MRI scores, the total Larsen scores, and the Larsen scores of the dominant-hand MCP joints (MCPs 2–5) for direct comparison with the MRI results. Results. The median disease duration was 5.1 years (range 0.5–29 years). Evidence of erosion progres- sion was identified by MRI in 30 patients (64%). The SDD based on the intraobserver scores was calculated as 3.25 units. Using this result, 11 patients (23%) showed evidence of erosion progression on MRI that was greater than the SDD. The SDD for progression based on the intraobserver total Larsen radiographic scores was 0.77 units, and the SDD for the Larsen scores of the dominant-hand MCP joints was 1.55 units. On the basis of these results, radiographic progression was noted in 19 patients (40%) by the total Larsen score and 7 patients (15%) by the dominant-hand MCP Larsen score. The most striking finding was that although MRI and radiograph scores identified a similar group of patients as having progression of joint damage, the radiographs of both hands appeared to be more respon- sive to change, albeit with the caveat that radiographic progression was most marked outside the dominant- hand MCP joints. Conclusion. There was no clear advantage of MRI with a limited field of view as compared with radio- graphic imaging of both hands in detecting progression Dr. Bird’s work is supported by a National Health and Medical Research Council postgraduate medical scholarship. 1 Paul Bird, BMed(Hons), FRACP, John Edmonds, MBBS, MA, FRACP, Marissa Lassere, MBBS(Hons), Grad Dip Epi, PhD, FRACP, FAPHM: St. George Hospital, and University of New South Wales, New South Wales, Australia; 2 Bruce Kirkham, MD, FRACP, MRCP: St. Thomas and Guy’s Hospital, London, UK; 3 Ian Portek, MBBS(Hons), FRACP, Ron Shnier, MBBS, FACR, Fredrick Joshua, MBBS, FRACP: St. George Hospital, Kogarah, New South Wales, Australia. Address correspondence and reprint requests to Paul Bird, BMed(Hons), FRACP, Rheumatology Department, St. George Hos- pital, Belgrave Street, Kogarah, New South Wales 2217, Australia. Email: pcbird@bigpond.com.au. Submitted for publication May 21, 2003; accepted in revised form January 10, 2004. 1383