Background/Purpose: To evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA).

Methods: Magnetic resonance imaging (MRI) of the dominant hand and foot of 26 consecutive, ACPA positive RA patients before and 6 months after initiation of methotrexate was obtained. RAMRIS of the hand was complemented by corresponding scoring of the foot (MTP I-V; HaF-score). DAS28 and a tender and swollen joint count of the joints scored in MRI were recorded. Changes in these scores (Δ) were assessed.

Results: ΔHaF-score correlated significantly with ΔDAS28 (r = 0.835, 95%-CI 0.661-0.923). Correlations to ΔDAS28 were best for changes in the synovitis subscore (0.695) and bone marrow edema (0.754). Correlations to ΔDAS28 were significantly better for of the ΔHaF-score than ΔRAMRIS (0.662, 0.369-0.835, p=0.0361). All patients with at least moderate response (EULAR criteria, n=11) had continuing disease activity on MRI without improvement in the HaF-score, including five cases with new erosions, three of them at the feet. Similarly, 12 patients had an improved joint count without improvement of the HaF-score. 6 of these discrepant findings were attributable to the foot. No patient fulfilled SDAI remission criteria.

Conclusion: The HaF-score identifies patients with continuing disease activity despite clinical response that would have been missed by consideration of the traditional RAMRIS or the DAS28 alone. Response as opposed to remission may be an insufficient goal in RA as all patients showed continuing disease activity, especially at the feet.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/advantages-of-a-combined-rheumatoid-arthritis-magnetic-resonance-imaging-score-ramris-for-hand-and-feet-does-the-ramris-of-the-hand-alone-underestimate-disease-activity-and-progression/