Background/Purpose: Magnetic resonance imaging (MRI) is a very useful modality that can directly visualize both inflammatory and structural changes of affected joints in patients with rheumatoid arthritis (RA). On another front, cytokines have pleiotropic and strong effector functions in inflammatory response and play an important role in pathogenesis of RA joints. However, it is still unclear MRI findings can reflect dynamic features of cytokines in RA.The aim of this study is to examine the association with hand MRI findings scored using Outcome Measures in Rheumatology (OMERACT) RA MRI scoring (RAMRIS) system and plasma cytokine levels in patients with RA.

Methods: In total of 98 newly diagnosed, untreated consecutive RA patients in our cohort (SAKURA study) were included. MRI of dominant wrist and finger joints were evaluated for synovitis, osteitis, tenosynovitis, JSN and bone erosions according to the latest OMERACT RAMRIS. MR images were assessed by 2 experienced radiologists independently, and the mean of their scores were used in the analysis. Ten cytokines including IL-6, VEGF, IL-1β, TNF-α, IL-8, GM-CSF, IFN-γ, IL-10, IL-12p70 and IL-2 in patients’ plasma were measured by electrochemiluminescence assay. Clinical and laboratory data were collected from their charts. The associations between RAMRIS scores and cytokine levels were examined by Spearman’s Rank Correlation Coefficient. The agreement of the two MRI readers was tested intraclass correlation coefficient (ICC).

Results: Seventy-seven (80.2 %) patients were female, 69 (71.9%) were positive for anti-CCP, and the median age and symptom duration were 59 years and 3.5 months, respectively. Mean disease activities score (DAS) 28 was 4.80. The median scores of RAMRIS were 5.75 for synovitis, 5.00 for osteitis, 4.00 for bone erosion, 2.50 for tenosynovitis and 1.00 for JSN. The ICCs of these scores were approximately 0.90 for all. RAMRIS synovitis and tenosynovitis scores were significantly correlated with DAS28, pain, global and evaluator Visual Analog Scale and Health Assessment Questionnaire-Disability Index. While RAMRIS synovitis, osteitis and tenosynovitis scores significantly correlated with plasma IL-6 ρ=0.410, p<0.001; ρ=0.381, p<0.001; ρ=0.337, p=0.001, repectively) and VEGF (ρ=0.296, p=0.003,; ρ=0.323, p=0.001; ρ=0.268, p=0.008, respctively), RAMRIS osteitis and bone erosion scores were significantly correlated with plasma IL-1β (ρ=0.221, p<0.031; ρ=0392, p<0.001). TNF and the other cytokines were not correlated with any RAMRIS score although IL-8 tended to correlate with osteitis score. In patients with anti-CCP antibody positive the correlations between RAMRIS synovitis and plasma levels of IL-6 and VEGF were more significant.

Conclusion: In newly diagnosed RA patients, synovial, bone and tendon inflammatory changes of hand MRI may reflect the high level of plasma IL-6 and VEGF, and plasma IL-1β may be associated with MRI bone involvements.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-hand-mri-findings-with-the-level-of-plasma-cytokines-in-patients-with-newly-diagnosed-rheumatoid-arthritis/