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

TY - JOUR

T1 - Determining a Magnetic Resonance Imaging Inflammatory Activity Acceptable State Without Subsequent Radiographic Progression in Rheumatoid Arthritis

T2 - Results from a Followup MRI Study of 254 Patients in Clinical Remission or Low Disease Activity

AU - Gandjbakhch, Frédérique

AU - Haavardsholm, Espen A

AU - Conaghan, Philip G

AU - Ejbjerg, Bo

AU - Foltz, Violaine

AU - Brown, Andrew K

AU - Døhn, Uffe Møller

AU - Lassere, Marissa

AU - Freeston, Jane E

AU - Olsen, Inge Christoffer

AU - Bøyesen, Pernille

AU - Bird, Paul

AU - Fautrel, Bruno

AU - Hetland, Merete Lund

AU - Emery, Paul

AU - Bourgeois, Pierre

AU - Hørslev-Petersen, Kim

AU - Kvien, Tore K

AU - McQueen, Fiona M

AU - Østergaard, Mikkel

PY - 2014/2

Y1 - 2014/2

N2 - 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. (First Release Dec 15 2013; J Rheumatol 2014;41:398-406; doi:10.3899/ jrheum.131088).

AB - 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. (First Release Dec 15 2013; J Rheumatol 2014;41:398-406; doi:10.3899/ jrheum.131088).

KW - Adult

KW - Aged

KW - Antirheumatic Agents

KW - Arthritis, Rheumatoid

KW - Disease Progression

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Longitudinal Studies

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Remission Induction

KW - Severity of Illness Index

KW - Synovitis

U2 - 10.3899/jrheum.131088

DO - 10.3899/jrheum.131088

M3 - Journal article

C2 - 24334647

SN - 0315-162X

VL - 41

SP - 398

EP - 406

JO - Journal of Rheumatology

JF - Journal of Rheumatology

IS - 2

ER -