Background/Purpose: EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA) states that magnetic resonance imaging (MRI) bone oedema (osteitis) is a strong independent predictor of subsequent radiographic progression in early RA and should be considered for use as a prognostic indicator. The development of rapid radiographic progression (RRP) is considered as a representative poor outcome in patients with RA.We have tried to examine whether MRI osteitis predict the further development of RRP in patients with early-stage RA from Nagasaki University Early Arthritis Cohort.

Methods: This is a 1-year observational study from seventy-six early-stage RA patients recruited consecutively from Nagasaki University Early Arthritis Cohort in which the subjects received Gd-enhanced MRI of both wrists and finger joints. All of the patients had been received DMARDs during 1 year after entry. Synovitis, osteitis and bone erosion determined by Gd-enhanced MRI was scored by Rheumatoid Arthritis Magnetic Resonance Imaging score (RAMRIS). Plain radiographic outcome of both wrists and finger joints was scored by Genant-modified Sharp score and the development of rapid radiographic progression (RRP) at 1 year in this study was identified as a score > 3/year. The clinical response toward introduction of DMARDs at each point (every 3 months) was defined according to DAS28-EULAR response criteria. Variables with a p value less than 0.20 were selected for the following multivariate logistic regression analyses. Starting with a full model, the most appropriate model was selected on the basis of Akaike’s information criteria in the SAS system®, version 9.2.

Results: Median age and disease duration at entry were 54.5 y.o and 3 months, respectively. Median RAMRIS synovitis score, RAMRIS osteitis score, RAMRIS bone erosion score and Genant-modified Sharp score at entry were 9, 1, 0, 0, respectively. RRP was developed in 12 patients at 1 year. Fifteen variables including gender, age, disease duration, DAS28-CRP, CRP (mg/dl), matrix metalloproteinase-3 (ng/dl), presence of RF, presence of ACPA, initial therapy with MTX, use of biologic DMARDs within the first 6 months, HAQ, RAMRIS synovitis score, RAMRIS osteitis score, RAMRIS bone erosion score and mTSS were evaluated to explore the development of RRP at 1 year. Multivariate logistic regression analyses have identified that RAMRIS osteitis score at baseline (1 increase, Odds ratio: 1.12, 95% C.I.: 1.06-1.19, p = 0.0002) is the only independent predictor toward the development of RRP at 1 year.

Conclusion: Present data suggest that MRI osteitis is closely associated with poor radiographic outcome in patients with early-stage RA. Physicians should especially consider the tight control of disease activity if MRI osteitis is obvious in early RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mri-osteitis-at-baseline-predicts-the-development-of-rapid-radiographic-progression-at-1-year-toward-patients-with-early-stage-rheumatoid-arthritis/