Session Information
Date: Monday, November 11, 2019
Title: 4M116: RA – Diagnosis, Manifestations, & Outcomes III: Diagnosis & Prognosis (1884–1889)
Session Type: ACR Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Based on a unique cohort of clinically suspect arthralgia (CSA) patients, we analysed which combinations of MRI-features at onset were predictive for Rheumatoid Arthritis (RA) development. This was done to increase our comprehension of locations of RA-onset and improve the predictive accuracy of MRI in CSA.
Methods: In the discovery cohort, 225 CSA-patients were followed on clinical arthritis development. Contrast-enhanced 1.5T MRIs were made of unilateral MCP(2-5), wrist and MTP(1-5)-joints at baseline and scored for synovitis, tenosynovitis and bone marrow edema. Severity, number and combinations of locations (joint/tendon/bone) with subclinical inflammation were determined, with symptom-free controls of similar age category as reference. Cox regression was used for predictor selection. Predictive values were determined at 1-year follow-up. Results were validated in 209 CSA-patients.
Results: In both cohorts 15% developed arthritis < 1-year. The multivariable Cox model selected presence of MCP-extensor peritendinitis (HR 4.38 (2.07-9.25)) and the number of locations with subclinical inflammation (1-2 locations HR 2.54 (1.11-5.82); ≥3 locations HR 3.75 (1.49-9.48)) as predictors (Figure 1). Severity and combinations of inflammatory lesions were not selected. Based on these variables, five risk-categories were defined: no subclinical inflammation, 1-2 or ≥3 locations, with or without MCP-extensor peritendinitis. Positive predictive values (PPVs) ranged 5% (lowest category; NPV 95%)-67%(highest category). Similar findings were obtained in the validation cohort; PPVs ranged 4% (lowest category; NPV 96%)-63%(highest category).
Conclusion: Tenosynovitis, particularly MCP-extensor peritendinitis, is among the first tissues affected by RA. Incorporating this feature and number of locations with subclinical inflammation improved prediction making with PPVs up to 63-67%.
The five risk-categories are:
0/Absent: 0 locations with subclinical inflammation without MCP extensor peritendinitis;
1-2/Absent: 1-2 locations with subclinical inflammation without MCP extensor peritendinitis;
>2/Absent: 3 or more locations with subclinical inflammation without MCP extensor peritendinitis;
1-2/Present: 1-2 locations with subclinical inflammation + MCP extensor peritendinitis;
>2/ Present: 3 or more locations with subclinical inflammation + MCP extensor peritendinitis
To cite this abstract in AMA style:
Matthijssen X, Wouters F, Boeters D, Boer A, Dakkak Y, Niemantsverdriet E, van der Helm-van Mil A. A Search to the Target Tissue in Which RA-specific Inflammation Starts: A Detailed MRI Study to Improve Identification of RA-specific Features in the Phase of Clinically Suspect Arthralgia [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/a-search-to-the-target-tissue-in-which-ra-specific-inflammation-starts-a-detailed-mri-study-to-improve-identification-of-ra-specific-features-in-the-phase-of-clinically-suspect-arthralgia/. Accessed .« Back to 2019 ACR/ARP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-search-to-the-target-tissue-in-which-ra-specific-inflammation-starts-a-detailed-mri-study-to-improve-identification-of-ra-specific-features-in-the-phase-of-clinically-suspect-arthralgia/