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I'm being treated for rheumatoid arthritis. So far, the X-rays look pretty good so the doctor thinks we've caught it early. No one seems to think having an MRI would be helpful, but I've heard they show early signs of joint change. What can you tell me about this?

The technology around MRIs continues to improve and advance every year. The quality is better now with a greater field of view. Detailed pictures of the soft tissues around the joints and the condition of the joints themselves are possible. Best of all, the patient isn't exposed to harmful radiation.

Newer MRIs have several field strengths beyond conventional MRIs. The high-field MRIs show the anatomy clearly in detailed images. Fluid, fat, and even bone edema are seen. Areas of inflammation show up well when a special dye is injected intravenously. Any erosion in the synovium (lining) of the joint is visible. In fact, MRIs can pick up fluid collection in the joint up to a year before any changes would show up on conventional X-rays.

The disadvantage of MRIs is their availability and cost. Some hospitals and clinics have an extremity MRI. The cost is less and because it's much smaller, it doesn't require an entire room of its own. This makes it more likely that more physicians will be able to offer this service to their patients in the future.

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