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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

When is an x-ray or MRI ordered to help detect erosions and joint damage related to arthritis? Are x-rays still ordered more often than MRI? Are MRI scans becoming more common?

A. When treating rheumatoid arthritis (RA), rheumatologists will take into account their patients symptoms, exam, lab, and radiographs (x-rays) in determining the proper course of therapy. Recently some doctors have started ordering MRI scans, an expensive radiologic procedure to help in their decision making. The thought is that an MRI can detect damage before a conventional radiograph (x-ray).

An MRI might be useful in a rheumatoid patient who has a normal x-ray (i.e. no changes of rheumatoid arthritis). If one sees erosions on MRI, the doctor might consider starting more aggressive treatments such as methotrexate or TNF blockers instead of using milder drugs such as hydroxychloroquine or sulfasalazine.

On the other hand, it is quite possible that changes seen on MRI may have little clinical significance on a patients long term course. More research is definitely needed to determine the utility of using MRI in the clinical setting before recommending it for most patients with RA. Some physicians may have recently purchased or rented an MRI scanner, so if your doctor has recommended an MRI, be sure to question them on how the results of the study would change (normal or abnormal) your treatment plan.

Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of Anti-TNF Blockers. The book is a must-have for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book.