Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression.

TY - JOUR

T1 - Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression.

AU - Haavardsholm, Espen A

AU - Bøyesen, Pernille

AU - Ostergaard, Mikkel

AU - Schildvold, Arnulf

AU - Kvien, Tore K

PY - 2008

Y1 - 2008

N2 - Objectives: To examine the spectrum and severity of magnetic resonance imaging (MRI) findings in patients with early rheumatoid arthritis (RA), and to investigate the predictive value of MRI findings for subsequent development of conventional radiographic (CR) damage and MRI erosions. Methods: 84 consecutive patients with RA with disease duration <1 year were enrolled. Patients were treated according to standard clinical practice, and evaluated at baseline, 3, 6 and 12 months by core measures of disease activity, conventional radiographs of both hands and wrists and MRI of the dominant wrist. MR images were scored according to the OMERACT rheumatoid arthritis magnetic resonance imaging score (RAMRIS), and conventional radiographs according to the van der Heijde modified Sharp score. Results: MRI findings reflecting inflammation (synovitis, bone marrow oedema and tenosynovitis) decreased during follow-up, while there was a small increase in MRI erosion score and CR damage. The proportion of patients with erosive progression at 1 year was 48% for conventional radiography and 66% for MRI. Baseline MRI bone marrow oedema (score >2 RAMRIS units) was identified as an independent predictor of both CR (odds ratio = 2.77 (95% confidence interval (CI) 1.06 to 7.21)) and MRI erosive progression (B = 0.21 (95% CI 0.08 to 0.34)). Conclusions: MRI findings were common in early RA, and MRI bone marrow oedema was an independent predictor of radiographic damage. These results suggest that MRI scans of the dominant wrist may help clinicians to determine which patients need early and aggressive treatment to avoid subsequent joint damage.  Rheumatoid arthritis (RA) is a chronic, inflammatory polyarthritis which frequently leads to progressive joint destruction. Many prognostic markers have been identified for RA, including demographic, genetic, environmental, clinical, immunological and radiographic factors. The most consistent and reliable prognostic factors of radiographic damage are high initial erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), the presence of rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) at baseline, the presence of shared-epitope alleles and early radiographic erosions.1 However, there is still a need for development of measures that can better distinguish between patients at risk for radiographic progression and those with a more favourable prognosis. Magnetic resonance imaging (MRI) is a highly sensitive method for detecting early inflammatory and structural abnormalities in RA joints.2-8 Although studies from smaller cohorts of 25-42 patients have shown encouraging data, less is known about the predictive value of MRI synovitis and bone marrow oedema for future erosive progression on conventional radiographic (CR) damage, and more knowledge from larger cohorts is needed in this field, especially in early RA.9 10 The aim of this prospective 1-year follow-up study was to examine the spectrum and severity of MRI findings in patients with RA of <1 year's duration. We also wanted to examine the association between MRI findings and clinical measures, and investigate the predictive value of early MRI findings for subsequent development of CR damage and MRI erosions.

AB - Objectives: To examine the spectrum and severity of magnetic resonance imaging (MRI) findings in patients with early rheumatoid arthritis (RA), and to investigate the predictive value of MRI findings for subsequent development of conventional radiographic (CR) damage and MRI erosions. Methods: 84 consecutive patients with RA with disease duration <1 year were enrolled. Patients were treated according to standard clinical practice, and evaluated at baseline, 3, 6 and 12 months by core measures of disease activity, conventional radiographs of both hands and wrists and MRI of the dominant wrist. MR images were scored according to the OMERACT rheumatoid arthritis magnetic resonance imaging score (RAMRIS), and conventional radiographs according to the van der Heijde modified Sharp score. Results: MRI findings reflecting inflammation (synovitis, bone marrow oedema and tenosynovitis) decreased during follow-up, while there was a small increase in MRI erosion score and CR damage. The proportion of patients with erosive progression at 1 year was 48% for conventional radiography and 66% for MRI. Baseline MRI bone marrow oedema (score >2 RAMRIS units) was identified as an independent predictor of both CR (odds ratio = 2.77 (95% confidence interval (CI) 1.06 to 7.21)) and MRI erosive progression (B = 0.21 (95% CI 0.08 to 0.34)). Conclusions: MRI findings were common in early RA, and MRI bone marrow oedema was an independent predictor of radiographic damage. These results suggest that MRI scans of the dominant wrist may help clinicians to determine which patients need early and aggressive treatment to avoid subsequent joint damage.  Rheumatoid arthritis (RA) is a chronic, inflammatory polyarthritis which frequently leads to progressive joint destruction. Many prognostic markers have been identified for RA, including demographic, genetic, environmental, clinical, immunological and radiographic factors. The most consistent and reliable prognostic factors of radiographic damage are high initial erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), the presence of rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) at baseline, the presence of shared-epitope alleles and early radiographic erosions.1 However, there is still a need for development of measures that can better distinguish between patients at risk for radiographic progression and those with a more favourable prognosis. Magnetic resonance imaging (MRI) is a highly sensitive method for detecting early inflammatory and structural abnormalities in RA joints.2-8 Although studies from smaller cohorts of 25-42 patients have shown encouraging data, less is known about the predictive value of MRI synovitis and bone marrow oedema for future erosive progression on conventional radiographic (CR) damage, and more knowledge from larger cohorts is needed in this field, especially in early RA.9 10 The aim of this prospective 1-year follow-up study was to examine the spectrum and severity of MRI findings in patients with RA of <1 year's duration. We also wanted to examine the association between MRI findings and clinical measures, and investigate the predictive value of early MRI findings for subsequent development of CR damage and MRI erosions.

U2 - http://dx.doi.org/10.1136/ard.2007.071977

DO - http://dx.doi.org/10.1136/ard.2007.071977

M3 - Journal article

SN - 0003-4967

VL - 67

SP - 794

EP - 800

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 6

ER -