Development and validation of rheumatoid arthritis magnetic resonance imaging inflammation thresholds associated with lack of damage progression

TY - JOUR

T1 - Development and validation of rheumatoid arthritis magnetic resonance imaging inflammation thresholds associated with lack of damage progression

AU - Baker, Joshua F.

AU - Østergaard, Mikkel

AU - Emery, Paul

AU - Baker, Daniel G.

AU - Conaghan, Philip G.

PY - 2017

Y1 - 2017

N2 - Objective To determine thresholds for rheumatoid arthritis (RA) magnetic resonance imaging scores (RAMRIS) associated with a low risk of structural damage progression. Methods MRI of the dominant hand was performed and RAMRIS scores determined at weeks 0, 24, and 52. X-rays were performed and van der Heijde-Sharp scores (vdHS) determined. In a development cohort (n=297) the changes in MRI erosion score and vdHS score were determined over the 24-week to 52-week interval and progression was defined as change > 0.5. We identified 24-week thresholds for synovitis and osteitis that provided > 90% sensitivity for imaging progression over the 24 to 52-week interval. The performance of these cut-offs was tested in a validation cohort (n=217). Results In the development cohort, synovitis or osteitis scores ≤3 by 24 weeks were associated with a low probability of progression on MRI and x-ray. The coefficient for osteitis was stronger than that of synovitis in models predicting x-ray and MRI progression. Therefore, a total inflammation score was weighted on osteitis (x2). An inflammation score ≤ 9 was more frequently attained than DAS28 remission (64 vs. 38) and was associated with low probability of progression regardless of attainment of clinical remission. In the validation cohort, there was a low odds of MRI progression among those with low synovitis [OR 0.27 (0.086,0.82) p=0.02], osteitis [OR 0.20 (0.085, 0.49) p < 0.001] and inflammation scores [OR 0.12 (0.033, 0.41) p=0.001]. Conclusion Attainment of low MRI single-hand synovitis and osteitis is not uncommon and predicts a lack of structural progression in RA, independent of clinical remission.

AB - Objective To determine thresholds for rheumatoid arthritis (RA) magnetic resonance imaging scores (RAMRIS) associated with a low risk of structural damage progression. Methods MRI of the dominant hand was performed and RAMRIS scores determined at weeks 0, 24, and 52. X-rays were performed and van der Heijde-Sharp scores (vdHS) determined. In a development cohort (n=297) the changes in MRI erosion score and vdHS score were determined over the 24-week to 52-week interval and progression was defined as change > 0.5. We identified 24-week thresholds for synovitis and osteitis that provided > 90% sensitivity for imaging progression over the 24 to 52-week interval. The performance of these cut-offs was tested in a validation cohort (n=217). Results In the development cohort, synovitis or osteitis scores ≤3 by 24 weeks were associated with a low probability of progression on MRI and x-ray. The coefficient for osteitis was stronger than that of synovitis in models predicting x-ray and MRI progression. Therefore, a total inflammation score was weighted on osteitis (x2). An inflammation score ≤ 9 was more frequently attained than DAS28 remission (64 vs. 38) and was associated with low probability of progression regardless of attainment of clinical remission. In the validation cohort, there was a low odds of MRI progression among those with low synovitis [OR 0.27 (0.086,0.82) p=0.02], osteitis [OR 0.20 (0.085, 0.49) p < 0.001] and inflammation scores [OR 0.12 (0.033, 0.41) p=0.001]. Conclusion Attainment of low MRI single-hand synovitis and osteitis is not uncommon and predicts a lack of structural progression in RA, independent of clinical remission.

KW - Clinical trials

KW - Magnetic resonance imaging

KW - Rheumatoid arthritis

KW - Structural damage

M3 - Journal article

C2 - 28134079

AN - SCOPUS:85028646432

SN - 0392-856X

VL - 35

SP - 607

EP - 613

JO - Clinical and Experimental Rheumatology

JF - Clinical and Experimental Rheumatology

IS - 4

ER -