MRI Characteristics Distinguishing Tuberculous Arthritis from Rheumatoid Arthritis: A Comparative Study.

OBJECTIVE: Skeletal tuberculosis (TB) arthritis is an uncommon but significant cause of osteoarticular morbidity, representing less than 1% of all TB cases. Delayed diagnosis often leads to persistent joint stiffness and pain. This study aims to identify early magnetic resonance imaging (MRI) features that distinguish TB arthritis from rheumatoid arthritis (RA). METHODS: The MRI scans were retrospectively analyzed from 2010 to 2017 of 21 patients diagnosed with TB arthritis and 82 patients with RA. Imaging characteristics including synovial effusion, synovial membrane thickness, abscess wall thickness, bony erosions, rice body formation, tenosynovitis, adjacent soft tissue inflammation, and joint space narrowing were compared between the 2 groups. RESULTS: Compared to RA, TB arthritis patients demonstrated significantly greater abscess wall thickening (P = .001) and rice body formation (P = .008), alongside less pronounced joint space narrowing. CONCLUSION: In patients presenting with chronic arthritis, the presence of thickened abscess walls, rice bodies, and relatively preserved joint space on MRI serve as early diagnostic markers favoring TB arthritis over RA. Cite this article as: Ting S, Chen J, Yu S, Hsu C, Chen Y. MRI characteristics distinguishing tuberculous arthritis from rheumatoid arthritis: A comparative study. Eur J Rheumatol. 2026, 13(2), 0058, doi: 10.5152/eurjrheum.2026.25058.