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Open Access Research article

Advantages of a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and feet: does the RAMRIS of the hand alone underestimate disease activity and progression?

Philipp Sewerin1*, Christian Buchbender2, Stefan Vordenbäumen1, Axel Scherer2, Falk Miese2, Ralph Brinks13, Hans-Joerg Wittsack2, Sabine Klein1, Matthias Schneider1, Gerald Antoch2 and Benedikt Ostendorf1

Author Affiliations

1 Department of Rheumatology, Univ Duesseldorf, Medical Faculty, Moorenstrasse 5, Duesseldorf D-40225, Germany

2 Department of Diagnostic and Interventional Radiology, Univ Duesseldorf, Medical Faculty, Duesseldorf D-40225, Germany

3 German Diabetes Center, Institute for Biometry and Epidemiology, Auf’m Hennekamp 65, Duesseldorf 40225, Germany

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BMC Musculoskeletal Disorders 2014, 15:104  doi:10.1186/1471-2474-15-104

Published: 26 March 2014



To evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA).


Magnetic resonance imaging (MRI, 0.2 Tesla) of the dominant hand and foot of 26 ACPA positive RA patients before and 6 months after initiation of methotrexate was obtained. RAMRIS of the hand was complemented by corresponding scoring of the foot (MTP I-V; HaF-score). Disease Activity Score 28 (DAS28) and a tender and swollen joint count (JC) of the joints scored in MRI were recorded. Changes in these scores (Δ) were assessed.


ΔHaF-score correlated significantly with ΔDAS28 (r = 0.820, 95%-CI 0.633-0.916). Correlations to ΔDAS28 were best for changes in the synovitis subscore (0.648) and bone marrow edema (0.703). Correlations to ΔDAS28 were significantly better for of the ΔHaF-score than ΔRAMRIS (0.499, 0.139-0.743, p = 0.0368).

All patients with at least moderate response (EULAR criteria, n = 11) had continuing disease activity on MRI, including five cases with new erosions, three of them at the feet. Improvements of the hand JC or foot JC were seen in 16 and 15 cases, respectively. However, MRI of the hand or feet improved in only 10 and 9 cases, respectively. No patient fulfilled SDAI remission criteria.


The HaF-score identifies patients with continuing disease activity despite clinical response that would have been missed by consideration of the traditional RAMRIS or the DAS28 alone. Response as opposed to remission may be an insufficient goal in RA as all patients showed continuing disease activity, especially at the feet.

Magnetic resonance imaging; Rheumatoid arthritis; RAMRIS; Therapy monitoring; Foot