Background/Purpose: Window of opportunity exists in the earlier phase of rheumatoid arthritis (RA), thus, early recognition of the RA patients who will develop rapid radiographic progression (RRP) is crucial. We have reported an importance of magnetic resonance imaging (MRI)-proven symmetrical synovitis, osteitis and bone erosion of wrist and finger joints toward the early classification of RA from the prospective early arthritis cohort at Nagasaki University, Nagasaki, Japan. To investigate whether MRI assessment of joint injury at baseline predict the development of RRP at 2 years in patients with early RA by our cohort.

Methods: One hundred-eleven RA patients, who fulfilled 2010 RA classification criteria and introduced disease-modifying anti-rheumatic drugs (DMARDs) including biologics within the first 1 year, were consecutively enrolled in this study. These patients were referred to the RA patients in the present study. Patients gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University. All of the subjects had been examined by gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MRI and plain radiograph of both wrist and finger joints at the same day every 6 months during 2 years. MRI-proven synovitis, osteitis and bone erosion were evaluated by RAMRI scoring (RAMRIS) technique. RRP was defined as yearly progression of Genant-modified Sharp score >3.0 during 2 years. We have examined what variables at entry, including MRI features, and the therapies during 2 years predict the development of RRP at 2 years by logistic regression analysis.

Results:

The mean disease duration, age, % female, prevalence or titer of rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA), disease activity score (DAS) 28-CRP at entry were 4.0 months, 56.2 y.o., 66.7%, 60.4% or 95.5 ± 186.7 IU/ml, 58.6% or 160.3 ± 345.4 U/ml and 4.38, respectively. The frequency of MRI-proven symmetrical synovitis, osteitis and bone erosion at baseline was 80.7, 54.5, 37.2%. Biologics were administrated in 17.1% of the patients during 2 years. Twenty patients (18.0%) were classified as RRP at 2 years. Logistic regression analysis has shown that MRI osteitis at baseline, history of biologics use during 2 years, Genant-modified Sharp score at baseline are independent variables to predict the development of RRP at 2 years (Odds ratio = 3.88, 7.95 and 12.4, respectively. 95% confidence interval = 1.05 – 14.42, 2.29 – 27.56 and 1.03-1.50, respectively, p-value = 0.043, 0.0011 and 0.027, respectively. Akaike’s information criterion = 91.50).

Conclusion:

Our present data indicate that MRI-proven osteitis at baseline is a predictor toward the development of RRP in patients with early RA. MRI is beneficial to find the window of opportunity in these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/magnetic-resonance-imaging-proven-osteitis-at-baseline-predicts-the-early-rheumatoid-arthritis-patients-who-will-develop-rapid-radiographic-progression-mri-is-beneficial-to-find-the-window-of-opportu/