Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state

Frédérique Gandjbakhch; Philip G Conaghan; Bo Ejbjerg; Espen A Haavardsholm; Violaine Foltz; Andrew K Brown; Uffe Møller Døhn; Marissa Lassere; Jane Freeston; Pernille Bøyesen; Paul Bird; Bruno Fautrel; Merete Lund Hetland; Paul Emery; Pierre Bourgeois; Kim Hørslev-Petersen; Tore K Kvien; Fiona McQueen; Mikkel Østergaard

doi:10.3899/jrheum.110421

Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state

Frédérique Gandjbakhch, Philip G Conaghan, Bo Ejbjerg, Espen A Haavardsholm, Violaine Foltz, Andrew K Brown, Uffe Møller Døhn, Marissa Lassere, Jane Freeston, Pernille Bøyesen, Paul Bird, Bruno Fautrel, Merete Lund Hetland, Paul Emery, Pierre Bourgeois, Kim Hørslev-Petersen, Tore K Kvien, Fiona McQueen, Mikkel Østergaard

82 Citations (Scopus)

Abstract

Objective. In rheumatoid arthritis (RA), radiographic progression may occur despite clinical remission. This may be explained by subclinical inflammation. Magnetic resonance imaging (MRI) provides a greater sensitivity than clinical examination and radiography for assessing disease activity. Our objective was to determine the MRI characteristics of RA patients in clinical remission or low disease activity (LDA) state. Methods. Databases from 6 cohorts were collected from 5 international centers. RA patients in clinical remission according to Disease Activity Score28-C-reactive protein (DAS28-CRP < 2.6; n = 213) or LDA-state (2.6 ≤ DAS28-CRP < 3.2; n = 81) with available MRI data were included. MRI were assessed according to the OMERACT RA MRI scoring system (RAMRIS). Results. Patient characteristics: 70% women, median age 55 (interquartile range, IQR 43-63) years, disease duration 2.3 (IQR 0.7-5.1) years, DAS28-CRP 2.2 (IQR 1.8-2.6), Simplified Disease Activity Index, SDAI, 3.9 (IQR 1.9-6.5), Clinical Disease Activity Index, CDAI, 3.1 (IQR 1.5- 5.8), rheumatoid factor/anti-cyclic citrullinated peptide positivity 57%/54%, presence of radiographic erosions: 66%. Wrist and metacarpophalangeal MRI (MCP-MRI) data were available for 287 and 241 patients, respectively. MRI inflammatory activity in wrist and/or MCP joints was observed in the majority [synovitis: 95%, bone edema (osteitis): 35%] of patients. The median (IQR) RAMRIS score was 6 (3-9) for synovitis and 0 (0-2) for osteitis. Synovitis and osteitis were not less frequent in DAS28 clinical remission (synovitis/osteitis 96%/35%) than LDA (91/36). A trend towards lower frequencies of osteitis in patients in SDAI and CDAI remission was observed. Conclusion. Subclinical inflammation was identified by MRI in the majority of RA patients in clinical remission or LDA state. This may explain structural progression in such patients. Further work is required to understand the place of modern imaging in future remission criteria. The Journal of Rheumatology

Original language	English
Journal	Journal of Rheumatology
Volume	38
Issue number	9
Pages (from-to)	2039-44
Number of pages	6
ISSN	0315-162X
DOIs	https://doi.org/10.3899/jrheum.110421
Publication status	Published - Sept 2011

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Gandjbakhch, F., Conaghan, P. G., Ejbjerg, B., Haavardsholm, E. A., Foltz, V., Brown, A. K., Møller Døhn, U., Lassere, M., Freeston, J., Bøyesen, P., Bird, P., Fautrel, B., Hetland, M. L., Emery, P., Bourgeois, P., Hørslev-Petersen, K., Kvien, T. K., McQueen, F., & Østergaard, M. (2011). Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state. Journal of Rheumatology, 38(9), 2039-44. https://doi.org/10.3899/jrheum.110421

Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state. / Gandjbakhch, Frédérique; Conaghan, Philip G; Ejbjerg, Bo et al.

In: Journal of Rheumatology, Vol. 38, No. 9, 09.2011, p. 2039-44.

Research output: Contribution to journal › Journal article › Research › peer-review

Gandjbakhch, F, Conaghan, PG, Ejbjerg, B, Haavardsholm, EA, Foltz, V, Brown, AK, Møller Døhn, U, Lassere, M, Freeston, J, Bøyesen, P, Bird, P, Fautrel, B, Hetland, ML, Emery, P, Bourgeois, P, Hørslev-Petersen, K, Kvien, TK, McQueen, F & Østergaard, M 2011, 'Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state', Journal of Rheumatology, vol. 38, no. 9, pp. 2039-44. https://doi.org/10.3899/jrheum.110421

@article{d82b3d1b301e4be48fc9096b8c7f42c9,

title = "Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state",

abstract = "Objective. In rheumatoid arthritis (RA), radiographic progression may occur despite clinical remission. This may be explained by subclinical inflammation. Magnetic resonance imaging (MRI) provides a greater sensitivity than clinical examination and radiography for assessing disease activity. Our objective was to determine the MRI characteristics of RA patients in clinical remission or low disease activity (LDA) state. Methods. Databases from 6 cohorts were collected from 5 international centers. RA patients in clinical remission according to Disease Activity Score28-C-reactive protein (DAS28-CRP < 2.6; n = 213) or LDA-state (2.6 ≤ DAS28-CRP < 3.2; n = 81) with available MRI data were included. MRI were assessed according to the OMERACT RA MRI scoring system (RAMRIS). Results. Patient characteristics: 70% women, median age 55 (interquartile range, IQR 43-63) years, disease duration 2.3 (IQR 0.7-5.1) years, DAS28-CRP 2.2 (IQR 1.8-2.6), Simplified Disease Activity Index, SDAI, 3.9 (IQR 1.9-6.5), Clinical Disease Activity Index, CDAI, 3.1 (IQR 1.5- 5.8), rheumatoid factor/anti-cyclic citrullinated peptide positivity 57%/54%, presence of radiographic erosions: 66%. Wrist and metacarpophalangeal MRI (MCP-MRI) data were available for 287 and 241 patients, respectively. MRI inflammatory activity in wrist and/or MCP joints was observed in the majority [synovitis: 95%, bone edema (osteitis): 35%] of patients. The median (IQR) RAMRIS score was 6 (3-9) for synovitis and 0 (0-2) for osteitis. Synovitis and osteitis were not less frequent in DAS28 clinical remission (synovitis/osteitis 96%/35%) than LDA (91/36). A trend towards lower frequencies of osteitis in patients in SDAI and CDAI remission was observed. Conclusion. Subclinical inflammation was identified by MRI in the majority of RA patients in clinical remission or LDA state. This may explain structural progression in such patients. Further work is required to understand the place of modern imaging in future remission criteria. The Journal of Rheumatology",

author = "Fr{\'e}d{\'e}rique Gandjbakhch and Conaghan, {Philip G} and Bo Ejbjerg and Haavardsholm, {Espen A} and Violaine Foltz and Brown, {Andrew K} and {M{\o}ller D{\o}hn}, Uffe and Marissa Lassere and Jane Freeston and Pernille B{\o}yesen and Paul Bird and Bruno Fautrel and Hetland, {Merete Lund} and Paul Emery and Pierre Bourgeois and Kim H{\o}rslev-Petersen and Kvien, {Tore K} and Fiona McQueen and Mikkel {\O}stergaard",

year = "2011",

month = sep,

doi = "10.3899/jrheum.110421",

language = "English",

volume = "38",

pages = "2039--44",

journal = "Journal of Rheumatology",

issn = "0315-162X",

publisher = "Journal of Rheumatology Publishing Co. Ltd.",

number = "9",

}

TY - JOUR

T1 - Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state

AU - Gandjbakhch, Frédérique

AU - Conaghan, Philip G

AU - Ejbjerg, Bo

AU - Haavardsholm, Espen A

AU - Foltz, Violaine

AU - Brown, Andrew K

AU - Møller Døhn, Uffe

AU - Lassere, Marissa

AU - Freeston, Jane

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

AU - Østergaard, Mikkel

PY - 2011/9

Y1 - 2011/9

N2 - Objective. In rheumatoid arthritis (RA), radiographic progression may occur despite clinical remission. This may be explained by subclinical inflammation. Magnetic resonance imaging (MRI) provides a greater sensitivity than clinical examination and radiography for assessing disease activity. Our objective was to determine the MRI characteristics of RA patients in clinical remission or low disease activity (LDA) state. Methods. Databases from 6 cohorts were collected from 5 international centers. RA patients in clinical remission according to Disease Activity Score28-C-reactive protein (DAS28-CRP < 2.6; n = 213) or LDA-state (2.6 ≤ DAS28-CRP < 3.2; n = 81) with available MRI data were included. MRI were assessed according to the OMERACT RA MRI scoring system (RAMRIS). Results. Patient characteristics: 70% women, median age 55 (interquartile range, IQR 43-63) years, disease duration 2.3 (IQR 0.7-5.1) years, DAS28-CRP 2.2 (IQR 1.8-2.6), Simplified Disease Activity Index, SDAI, 3.9 (IQR 1.9-6.5), Clinical Disease Activity Index, CDAI, 3.1 (IQR 1.5- 5.8), rheumatoid factor/anti-cyclic citrullinated peptide positivity 57%/54%, presence of radiographic erosions: 66%. Wrist and metacarpophalangeal MRI (MCP-MRI) data were available for 287 and 241 patients, respectively. MRI inflammatory activity in wrist and/or MCP joints was observed in the majority [synovitis: 95%, bone edema (osteitis): 35%] of patients. The median (IQR) RAMRIS score was 6 (3-9) for synovitis and 0 (0-2) for osteitis. Synovitis and osteitis were not less frequent in DAS28 clinical remission (synovitis/osteitis 96%/35%) than LDA (91/36). A trend towards lower frequencies of osteitis in patients in SDAI and CDAI remission was observed. Conclusion. Subclinical inflammation was identified by MRI in the majority of RA patients in clinical remission or LDA state. This may explain structural progression in such patients. Further work is required to understand the place of modern imaging in future remission criteria. The Journal of Rheumatology

AB - Objective. In rheumatoid arthritis (RA), radiographic progression may occur despite clinical remission. This may be explained by subclinical inflammation. Magnetic resonance imaging (MRI) provides a greater sensitivity than clinical examination and radiography for assessing disease activity. Our objective was to determine the MRI characteristics of RA patients in clinical remission or low disease activity (LDA) state. Methods. Databases from 6 cohorts were collected from 5 international centers. RA patients in clinical remission according to Disease Activity Score28-C-reactive protein (DAS28-CRP < 2.6; n = 213) or LDA-state (2.6 ≤ DAS28-CRP < 3.2; n = 81) with available MRI data were included. MRI were assessed according to the OMERACT RA MRI scoring system (RAMRIS). Results. Patient characteristics: 70% women, median age 55 (interquartile range, IQR 43-63) years, disease duration 2.3 (IQR 0.7-5.1) years, DAS28-CRP 2.2 (IQR 1.8-2.6), Simplified Disease Activity Index, SDAI, 3.9 (IQR 1.9-6.5), Clinical Disease Activity Index, CDAI, 3.1 (IQR 1.5- 5.8), rheumatoid factor/anti-cyclic citrullinated peptide positivity 57%/54%, presence of radiographic erosions: 66%. Wrist and metacarpophalangeal MRI (MCP-MRI) data were available for 287 and 241 patients, respectively. MRI inflammatory activity in wrist and/or MCP joints was observed in the majority [synovitis: 95%, bone edema (osteitis): 35%] of patients. The median (IQR) RAMRIS score was 6 (3-9) for synovitis and 0 (0-2) for osteitis. Synovitis and osteitis were not less frequent in DAS28 clinical remission (synovitis/osteitis 96%/35%) than LDA (91/36). A trend towards lower frequencies of osteitis in patients in SDAI and CDAI remission was observed. Conclusion. Subclinical inflammation was identified by MRI in the majority of RA patients in clinical remission or LDA state. This may explain structural progression in such patients. Further work is required to understand the place of modern imaging in future remission criteria. The Journal of Rheumatology

U2 - 10.3899/jrheum.110421

DO - 10.3899/jrheum.110421

M3 - Journal article

SN - 0315-162X

VL - 38

SP - 2039

EP - 2044

JO - Journal of Rheumatology

JF - Journal of Rheumatology

IS - 9

ER -

Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state

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