Are Magnetic Resonance Imaging Features of the Hand Associated with Patient Reported Physical Function, Global Assessment of Disease Activity, Pain and Health Related Quality of Life in Rheumatoid Arthritis in Clinical Remission? - Longitudinal Results from an Observational Cohort

Daniel Glinatsi¹, Cecilie Heegaard Brahe², Merete Lund Hetland^1,3,4, Lykke Ørnbjerg¹, Simon Krabbe⁵, Joshua Baker⁶, Mikael Boesen⁷, Zoreh Rastiemadabadi⁸, Lone Morsel-Carlsen^8,9, Henrik Rogind^1,3, Hanne Slott Jensen¹⁰, Annette Hansen¹¹, Jesper Nørregaard¹², Søren Jacobsen^3,13, Lene Terslev¹, Tuan Huynh¹², Natalia Manilo¹⁴, Dorte Vendelbo Jensen^1,15, Jakob M. Møller¹⁶, Niels Steen Krogh¹⁵ and Mikkel Østergaard^1,3,17, ¹Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark, Copenhagen, Denmark, ²Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark, Glostrup, Denmark, ³University of Copenhagen, Copenhagen, Denmark, ⁴The DANBIO Registry, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark, ⁵Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark, ⁶Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, ⁷Department of Radiology and the Parker institute, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark, ⁸Department of Radiology, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark, ⁹Department of Radiology, Rigshospitalet, Copenhagen, Denmark, ¹⁰Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Frederiksberg, Denmark, Copenhagen, Denmark, ¹¹Department of Rheumatology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark, ¹²Center for Rheumatology and Spine Diseases, Nordsjællands Hospital, Hillerød, Denmark, ¹³Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, ¹⁴Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Frederiksberg, Copenhagen, Denmark, ¹⁵The DANBIO Registry, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, ¹⁶Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark, ¹⁷Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Magnetic resonance imaging (MRI), patient-reported outcome measures, physical function and rheumatoid arthritis (RA)

Session Information

Date: Sunday, November 5, 2017

Title: Imaging of Rheumatic Diseases Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: To assess whether magnetic resonance imaging (MRI) inflammation and damage in the wrist and hand of rheumatoid arthritis (RA) patients are associated with patient-reported outcomes (PROs) at clinical remission and relapse.

Methods: MRIs of the right wrist and hand were obtained in 114 patients with established RA in sustained clinical remission (>1 year), before tapering their biologic disease-modifying antirheumatic drug. MRIs were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI score (RAMRIS) for inflammation (synovitis/tenosynovitis/osteitis) and damage (bone erosions/joint space narrowing (JSN)) at baseline (i.e. remission, n=114) and in case of a relapse (n=70). Status and change MRI-scores were assessed for associations with patient-reported physical function (health assessment questionnaires (HAQ)), visual analogue scales for global disease activity and pain, EuroQol 5 dimensions and Short Form 36 physical and mental component summary (SF-36 PCS/MCS) using Spearman correlations, and in univariate/multivariable linear regression analyses including generalized estimating equations. C-reactive protein and swollen joint counts were forced into the models. MRI features were also assessed for trends against specific hand-related HAQ-items using Jonckheere trend tests.

Results: MRI-assessed bone erosion, JSN and combined damage score were associated with impaired PROs, mainly HAQ and SF-36 PCS at clinical remission and relapse (p<0.01), independent of clinical measures. The levels of bone erosions and JSN were associated with the level of the HAQ score in 4 of 5 hand-related HAQ-items (p<0.05). MRI-assessed inflammation was generally not associated with PROs at remission or relapse.

Conclusion: In patients with established RA MRI-assessed wrist and hand damage, but not inflammation is associated with patient-reported physical impairment at clinical remission and relapse, and the amount of damage in the wrist and hand is associated with reduced function of the hand.

HAQ

VAS-PtGlobal

VAS-Pain

Univariate

Multivariable

Univariate

Multivariable

Univariate

Multivariable

β (95% CI)

MRI Synovitis

0.00

(-0.03;0.03)

0.97

-0.39

(-1.63;0.84)

0.53

-0.31

(-1.37;0.76)

0.57

MRI Tenosynovitis

0.00

(-0.03;0.03)

0.77

0.58

(-0.95;2.10)

0.46

0.67

(-0.63;1.96)

0.31

MRI Osteitis

0.00

(-0.02;0.03)

0.86

0.51

(-0.36;1.38)

0.25

0.21

(-0.55;0.97)

0.59

MRI Bone Erosion

0.01 (0.00;0.01)

0.001

0.01

(0.00;0.01)

0.001**

0.04

(-0.08;0.15)

0.52

0.06

(-0.06;0.17)

0.34

MRI JSN

0.01

(0.00;0.02)

0.002

0.01

(0.00;0.02)

0.001**

0.09

(-0.14;0.33)

0.44

0.12

(-0.11;0.35)

0.32

MRI Combined Inflammation

0.00

(-0.01;0.02)

0.83

0.08

(-0.48;0.64)

0.77

-0.03

(-0.42;0.49)

0.89

MRI Combined Damage*

0.004

(0.000.01)

0.002

0.004

(0.00;0.01)

0.001

0.03

(-0.05;0.10)

0.49

0.04

(-0.04;0.11)

0.33

SF-36 PCS

SF-36 MCS

EQ-5D

Univariate

Multivariable

Univariate

Multivariable

Univariate

Multivariable

β (95% CI)

MRI Synovitis

-0.04

(-0.55;0.46)

0.88

0.14

(-0.32;0.60)

0.55

0.00

(-0.01;0.01)

0.88

MRI Tenosynovitis

-0.04

(-0.68;0.60)

0.91

0.18

(-0.34;0.69)

0.51

0.00

(-0.01;0.01)

0.78

MRI Osteitis

-0.08

(-0.46;0.30)

0.67

-0.05

(-0.52;0.42)

0.84

0.00

(-0.01;0.00)

0.43

MRI Bone Erosion

-0.07

(-0.12;-0.02)

0.004

-0.08

(-0.13;-0.03)

0.001**

0.01

(-0.05;0.07)

0.75

0.00

(0.00;0.00)

0.57

MRI JSN

-0.14

(-0.24;-0.05)

0.004

-0.16

(-0.27;-0.06)

0.002**

0.02

(-0.10;0.14)

0.78

0.00

(-0.00;0.00)

0.63

MRI Combined Inflammation

-0.02

(-0.25;0.21)

0.85

0.06

(-0.20;0.32)

0.63

0.00

(0.00;0.00)

0.75

MRI Combined Damage*

-0.05

(-0.08;-0.02)

0.003

-0.06

(-0.09;-0.02)

0.001

0.01

(-0.03;0.04)

0.76

0.00

(0.00;0.00)

0.59

Table 4. Univariate and multivariable general estimating equations (GEEs) for the association between MRI features and PROs. All analyses were adjusted for age and sex.

*If combined damage scores had a p-value ≤0.10 in univariate analyses, these were included in a separate multivariable model with CRP and SJC included in the model. **This parameter was included in a separate multivariable GEE model with SJC and CRP, due to co-linearity between bone erosion and JSN.

Abbreviations: HAQ: Health assessment questionnaire, VAS: Visual analogue scale, PtGlobal: Patient’s assessment of global disease activity, MRI: Magnetic resonance imaging, JSN: Joint space narrowing, SF-36: Short Form 36, PCS: Physical component summary, MCS: Mental component summary, EQ-5D: EuroQol 5 dimensions.

Disclosure: D. Glinatsi, None; C. H. Brahe, None; M. Lund Hetland, None; L. Ørnbjerg, None; S. Krabbe, None; J. Baker, None; M. Boesen, None; Z. Rastiemadabadi, None; L. Morsel-Carlsen, None; H. Rogind, None; H. S. Jensen, None; A. Hansen, Calgene, 5,Pfizer Inc, 5,Abvie, 6; J. Nørregaard, None; S. Jacobsen, None; L. Terslev, None; T. Huynh, None; N. Manilo, None; D. V. Jensen, None; J. M. Møller, None; N. S. Krogh, None; M. Østergaard, None.

To cite this abstract in AMA style:

Glinatsi D, Brahe CH, Lund Hetland M, Ørnbjerg L, Krabbe S, Baker J, Boesen M, Rastiemadabadi Z, Morsel-Carlsen L, Rogind H, Jensen HS, Hansen A, Nørregaard J, Jacobsen S, Terslev L, Huynh T, Manilo N, Jensen DV, Møller JM, Krogh NS, Østergaard M. Are Magnetic Resonance Imaging Features of the Hand Associated with Patient Reported Physical Function, Global Assessment of Disease Activity, Pain and Health Related Quality of Life in Rheumatoid Arthritis in Clinical Remission? – Longitudinal Results from an Observational Cohort [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/are-magnetic-resonance-imaging-features-of-the-hand-associated-with-patient-reported-physical-function-global-assessment-of-disease-activity-pain-and-health-related-quality-of-life-in-rheumatoid-art/. Accessed .

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