Determining a magnetic resonance imaging inflammatory activity acceptable state without subsequent radiographic progression in rheumatoid arthritis: results from a followup MRI study of 254 patients in clinical remission or low disease activity.

Abstract

OBJECTIVE:

To assess the predictive value of magnetic resonance imaging (MRI)-detected subclinical inflammation for subsequent radiographic progression in a longitudinal study of patients with rheumatoid arthritis (RA) in clinical remission or low disease activity (LDA), and to determine cutoffs for an MRI inflammatory activity acceptable state in RA in which radiographic progression rarely occurs.

METHODS:

Patients with RA in clinical remission [28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6, n = 185] or LDA state (2.6 ≤ DAS28-CRP < 3.2, n = 69) with longitudinal MRI and radiographic data were included from 5 cohorts (4 international centers). MRI were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS). Statistical analyses included an underlying conditional logistic regression model stratified per cohort, with radiographic progression as dependent variable.

RESULTS:

A total of 254 patients were included in the multivariate analyses. At baseline, synovitis was observed in 95% and osteitis in 49% of patients. Radiographic progression was observed in 60 patients (24%). RAMRIS synovitis was the only independent predictive factor in multivariate analysis. ROC analysis identified a cutoff value for baseline RAMRIS synovitis score of 5 (maximum possible score 21). Rheumatoid factor (RF) status yielded a significant interaction with synovitis (p value = 0.044). RF-positive patients with a RAMRIS synovitis score of > 5 vs ≤ 5, had an OR of 4.4 (95% CI 1.72-11.4) for radiographic progression.

CONCLUSION:

High MRI synovitis score predicts radiographic progression in patients in clinical remission/LDA. A cutoff point for determining an MRI inflammatory activity acceptable state based on the RAMRIS synovitis score was established. Incorporating MRI in future remission criteria should be considered.

• Authors: Frédérique Gandjbakhch, Espen A Haavardsholm, Philip G Conaghan, Bo Ejbjerg, Violaine Foltz, Andrew K Brown, Uffe Møller Døhn, Marissa Lassere, Jane E Freeston, Inge Christoffer Olsen, Pernille Bøyesen, Paul Bird, Bruno Fautrel, Merete Lund Hetland, Paul Emery, Pierre Bourgeois, Kim Hørslev-Petersen, Tore K Kvien, Fiona M McQueen, Mikkel Østergaard
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 41 Issue 2 Pg. 398-406 (Feb 2014) ISSN: 0315-162X [Print] Canada
• PMID: 24334647 (Publication Type: Journal Article)

Chemical References

• Antirheumatic Agents

Topics

• Adult
• Aged
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy, pathology)
• Disease Progression
• Female
• Follow-Up Studies
• Humans
• Longitudinal Studies
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Remission Induction
• Severity of Illness Index
• Synovitis (drug therapy, pathology)