Extracapsular and joint-dominant hand and wrist MRI patterns in psoriatic and rheumatoid arthritis: an exploratory case-control study
9 affiliations
- 1Hubei University of Chinese Medicine
- 2Department of Dermatology, Traditional Chinese and Western Medicine Hospital, Hubei University of Chinese Medicine
- 3Department of Dermatology, Wuhan No. 1 Hospital
- 4Department of Radiology, Wuhan No. 1 Hospital
- 5Tongji Medical College, Huazhong University of Science and Technology
- 6Department of Rheumatology and Immunology, Wuhan No. 1 Hospital
- 7School of Medicine, Jianghan University
- 8Hubei Province and Key Laboratory of Skin Infection and Immunity, Hubei Provincial Clinical Research Center for Infectious Skin Diseases
- 9Dermatology Hospital, Southern Medical University
Abstract
Background: Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) may present with overlapping hand and wrist symptoms, while their anatomical patterns of inflammation differ.
Objective: To compare prespecified hand and wrist magnetic resonance imaging (MRI) features between PsA and RA and to assess selected exploratory associations, discriminatory performance, anatomical distributions and reader reliability.
Methods: This retrospective case-control study included 41 patients with PsA and 41 with RA who underwent clinically acquired 3.0-T hand or wrist MRI. Research MRI features were assigned retrospectively by readers blinded to the clinical diagnosis. Between-group comparisons used available-case denominators. Each adjusted model included one MRI feature together with age, sex and symptom duration; Firth bias-reduced logistic regression was used for the sparse vascular-like signal feature.
Results: Compared with RA, PsA had higher median scores for extracapsular soft tissue inflammation (7 vs. 2), periarthritis (8 vs. 4) and bead-like peritendinous effusion (1 vs. 0; all P <0.01). Study-defined prominent reticular vascular-like signal occurred in 35/41 patients with PsA and 2/41 with RA and showed a strong but imprecise adjusted association with PsA (odds ratio 85.02, 95% CI 15.07–479.83). RA had a higher median joint effusion score (5 vs. 2) and more frequent wrist synovitis (33/41 vs. 7/37) and wrist bone erosion (30/41 vs. 8/39; all P <0.01). Inter-reader coefficients ranged from 0.574 to 0.914 and intra-reader coefficients from 0.846 to 0.968.
Limitations: The historical screening denominator and formal composite disease activity scores could not be reconstructed; one clinically diagnosed RA case did not meet the retrospective classification threshold; treatment exposure differed between groups; distal interphalangeal and ulnocarpal coverage was incomplete; and external validation was not performed.
Conclusion: In this exploratory cohort, extracapsular and enthesis-associated MRI findings favored PsA, whereas joint effusion and wrist synovitis or erosion favored RA. The study-defined vascular-like and bead-like features require independent validation before clinical use.
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BibTeX
@article{huang2026extracapsular,
title = {{Extracapsular and joint-dominant hand and wrist MRI patterns in psoriatic and rheumatoid arthritis: an exploratory case-control study}},
author = {Juan Huang and Shaohui Song and Quanhong Zhang and Qiuyu Fan and Yue Li and Yiqian Peng and Yue Zhu and Gang Hu and Lang Yu and Jingru Chen and Liuqing Chen and Ping Xia and Jinbo Chen},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1945180},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1945180/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Extracapsular and joint-dominant hand and wrist MRI patterns in psoriatic and rheumatoid arthritis: an exploratory case-control study
AU - Juan Huang
AU - Shaohui Song
AU - Quanhong Zhang
AU - Qiuyu Fan
AU - Yue Li
AU - Yiqian Peng
AU - Yue Zhu
AU - Gang Hu
AU - Lang Yu
AU - Jingru Chen
AU - Liuqing Chen
AU - Ping Xia
AU - Jinbo Chen
PY - 2026
DA - 2026/10/20
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1945180
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1945180/full
AB - Background: Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) may present with overlapping hand and wrist symptoms, while their anatomical patterns of inflammation differ. Objective: To compare prespecified hand and wrist magnetic resonance imaging (MRI) features between PsA and RA and to assess selected exploratory associations, discriminatory performance, anatomical distributions and reader reliability. Methods: This retrospective case-control study included 41 patients with PsA and 41 with RA who underwent clinically acquired 3.0-T hand or wrist MRI. Research MRI features were assigned retrospectively by readers blinded to the clinical diagnosis. Between-group comparisons used available-case denominators. Each adjusted model included one MRI feature together with age, sex and symptom duration; Firth bias-reduced logistic regression was used for the sparse vascular-like signal feature. Results: Compared with RA, PsA had higher median scores for extracapsular soft tissue inflammation (7 vs. 2), periarthritis (8 vs. 4) and bead-like peritendinous effusion (1 vs. 0; all P <0.01). Study-defined prominent reticular vascular-like signal occurred in 35/41 patients with PsA and 2/41 with RA and showed a strong but imprecise adjusted association with PsA (odds ratio 85.02, 95% CI 15.07–479.83). RA had a higher median joint effusion score (5 vs. 2) and more frequent wrist synovitis (33/41 vs. 7/37) and wrist bone erosion (30/41 vs. 8/39; all P <0.01). Inter-reader coefficients ranged from 0.574 to 0.914 and intra-reader coefficients from 0.846 to 0.968. Limitations: The historical screening denominator and formal composite disease activity scores could not be reconstructed; one clinically diagnosed RA case did not meet the retrospective classification threshold; treatment exposure differed between groups; distal interphalangeal and ulnocarpal coverage was incomplete; and external validation was not performed. Conclusion: In this exploratory cohort, extracapsular and enthesis-associated MRI findings favored PsA, whereas joint effusion and wrist synovitis or erosion favored RA. The study-defined vascular-like and bead-like features require independent validation before clinical use.
SN - 1664-3224
ER -