Background/Purpose The assessment of joint destruction in rheumatoid arthritis (RA) patients being treated with biologics is normally mainly carried out for small joints. There are a few reports that have so far assessed joint destruction of large joints, and no reports that assess joint destruction of the shoulder joint. The aim of this study was therefore to assess the risk factors for shoulder joint destruction in RA patients being treated with biologics based on the findings of both the magnetic resonance imaging (MRI) and 18F-fluorodeoxy glucose positron emission tomography (PET).

Methods Twenty-nine shoulders (5 male shoulders, 25 female shoulders; 16 right shoulders, 14 left shoulders) in 30 patients with RA were assessed using PET and MRI before starting biologics and then again six months later. The mean age (range) was 54 (18-72) years and the mean disease duration was 7 (0.8-30) years. The XP findings were assessed before starting biologics and then again three years later. The CRP, ESR and MMP-3 levels, and the DAS28-ESR, DAS28-CRP, CDAI and SDAI scores were also assessed. We compared these parameters between the progression of joint destruction group (P group) and the no progression group (N group).

Results The SUV max, the rates of synovitis and the rates of rotator cuff tear on MRI before biologics treatment were significantly higher in the P group than in the N group. The SUV max and synovitis detected by MRI after biologics were also significantly higher in the P group. The CRP, ESR and MMP-3 levels and disease activity showed no significant differences between the two groups. RA patients who had severe joint destruction (Larsen grade ≧ Ⅲ) before starting biologics demonstrated　a significantly greater progression of shoulder joint destruction than the patients who had  mild joint destruction (Larsen grade ≦ Ⅱ) before starting biologics.

Conclusion The detection of synovitis by PET or MRI is thus considered to be more important than the disease activity and serum inflammation markers when assessing the potential for a progression of shoulder joint destruction. In addition, a previous history of joint destruction and rotator cuff tears is also an important factor for the evaluation of shoulder joint destruction in RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analysis-of-shoulder-joint-destruction-in-rheumatoid-arthritis-patients-treated-with-biologics/