Rheumatoid Arthritis — SCE Rheumatology MCQ
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Correct answer: B — It predicts subsequent erosive structural progression
MRI bone marrow oedema in rheumatoid arthritis corresponds to inflammatory marrow involvement, commonly termed osteitis. In early RA it is an independent prognostic marker for subsequent erosive or radiographic structural progression, including when initial radiographs are normal. It is therefore included as an inflammatory domain in RAMRIS. Synovitis and tenosynovitis further support active inflammatory disease. Bone marrow oedema is not completely disease-specific, but in this established RA context it does not primarily indicate infection or osteoarthritis; those diagnoses require an appropriate clinical pattern and other imaging or microbiological evidence. It is neither a normal age-related finding nor a marker of inactive disease. The finding informs prognosis but does not, by itself, mandate treatment escalation outside standard clinical treat-to-target assessment.
Reference: Bøyesen P et al. MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression. Annals of the Rheumatic Diseases. 2011;70:428–433. https://pubmed.ncbi.nlm.nih.gov/20810395/