Magnetic Resonance Imaging (MRI) Joint Space Narrowing Is an Independent Predictor of Radiographic and MRI Damage Progression in Patients with Early Rheumatoid Arthritis

Signe Møller-Bisgaard¹, Bo Jannik Ejbjerg², Iris Eshed³, Kim Hørslev-Petersen⁴, Merete Lund Hetland^5,6, Anne Grethe Jurik⁷, Henrik S Thomsen⁸, Trine Torfing⁹, Kristian Stengaard-Pedersen¹⁰, Peter Junker¹¹, Niels Steen Krogh¹², Tine Lottenburger¹³, Torkell Ellingsen¹⁴, Lis Smedegaard Andersen¹⁵, Henrik Skjødt¹⁶, Anders Svendsen¹⁴, Ulrik Tarp¹⁰, Ib Tønder Hansen¹⁰, Jan Pødenphant¹⁵, Jens Kristian Pedersen¹⁴, Hanne Lindegaard¹⁴, Aage Vestergaard¹⁷, Daniel Glinatsi¹⁶ and Mikkel Østergaard¹⁶, ¹Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, Glostrup, Denmark, ²Department of Rheumatology, Slagelse University Hospital, Slagelse, Denmark, ³Department of Radiology, Sheba Medical Center, Israel, Tel Hashomer, Israel, ⁴King Christian X Hospital for Rheumatic Diseases, Graasten, Denmark, ⁵Danish Rheumatologic Biobank and DANBIO registry, Rigshospitalet, Glostrup, Gentofte and Herlev University Hospital, Copenhagen, Denmark, ⁶Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark,, Copenhagen, Denmark, ⁷Department of Radiology, Aarhus University Hospital, Aarhus, Denmark, ⁸Department of Radiology, Herlev University Hospital, Copenhagen, Denmark, ⁹Department of Radiology, Odense University Hospital, Odense, Denmark, ¹⁰Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, ¹¹University of Southern Denmark, Odense, Denmark, ¹²ZiteLab ApS, Copenhagen, Denmark, ¹³Department of Medicine, Vejle Regional Hospital, Vejle, Denmark, ¹⁴Department of Rheumatology, Odense University Hospital, Odense, Denmark, ¹⁵Department of Rheumatology, Gentofte University Hospital, Gentofte, Denmark, ¹⁶Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, Glostrup, Denmark, ¹⁷Department of Radiology, Hvidovre University Hospital, Denmark, Hvidovre, Denmark

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Imaging, MRI and rheumatoid arthritis (RA)

Session Information

Date: Sunday, November 13, 2016

Title: Imaging of Rheumatic Diseases I: Advanced Imaging in RA and Spondyloarthritides

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Magnetic Resonance Imaging (MRI) osteitis and synovitis have been identified as predictors of structural damage progression in rheumatoid arthritis (RA)^1,2, but the predictive value of MRI joint space narrowing (JSN, a measure of cartilage damage) and tenosynovitis needs further investigation. The purpose was to investigate the predictive value of baseline MRI inflammatory and damage parameters on 2 year MRI and X-ray damage progression in an early RA (eRA) cohort following a non biologic treat-to-target strategy.

Methods: In 129 eRA (<6months) patients from the double-blind randomized CIMESTRA trial (randomized to receive methotrexate, intraarticular betamethasone and cyclosporine (CYA)/placebo CYA) contrast-enhanced MRIs of the non-dominant wrist and X-rays of hands and feet were performed at baseline and after 2 years. MRIs were evaluated according to the RAMRIS scoring system for osteitis, synovitis, erosion, JSN, and for tenosynovitis according to Haavardsholm et al³. X-rays were evaluated according to the Sharp/van der Heijde method. MRIs and X-rays were read with known chronology by two experienced radiologists. Potential predictive baseline variables (MRI osteitis, synovitis, tenosynovitis, erosion, JSN, X-ray erosion and JSN, DAS28, gender, age, anti-CCP, smoking status) were tested in univariate linear regression analyses with 2-year change in MRI total damage score, Total Sharp Score (TSS), and MRI and X-ray JSN and erosion scores as dependent variables. Significant variables (p<0.05) were included in multiple regression analyses with backward selection.

Results: Independent predictors of structural damage progression are presented in table 1. If MRI JSN was not included in the model, MRI osteitis score was statistically significant independent predictor of X-ray progression (coefficient 0.32, p=0.001, vs. TSS progression).

Table 1
Final Models
	Dependent variables
	MRI variables			X-ray variables
	MRI erosion	MRI JSN	MRI total damage score	X-ray erosion	X-ray JSN	TSS
Explanatory variables	Coefficient(CI)	Coefficient(CI)	Coefficient(CI)	Coefficient(CI)	Coefficient(CI)	Coefficient(CI)
MRI synovitis	0.23 (0.06-0.31) p=0.006		0.18 (0.03-0.36) p=0.023
MRI JSN	0.39 (0.27-0.68) p<0.001	0.66 (0.35-0.54) p<0.001	0.54 (0.66-1.17) p<0.001	0.41 (0.89-2.15) p<0.001	0.24 (0.12-0.83) p<0.001	0.39 (1.10-2.82) p<0.001
MRI total damage score: sum score of MRI erosion and JSN; CI: Confidence Interval

Conclusion: This trial is the first to report that MRI JSN independently predicts both X-ray and MRI damage progression in early RA. Further studies are needed to confirm early MRI-determined cartilage damage as predictor of progressive joint destruction in RA. References: 1. Hetland et al, Ann Rheum Dis 2009;68(3) 2. Boyesen et al, Ann Rheum Dis 2011;70(3) 3 Haavardsholm et al, Ann Rheum Dis 2007;66(9)

Disclosure: S. Møller-Bisgaard, None; B. J. Ejbjerg, None; I. Eshed, None; K. Hørslev-Petersen, None; M. Lund Hetland, None; A. G. Jurik, None; H. S. Thomsen, None; T. Torfing, None; K. Stengaard-Pedersen, None; P. Junker, None; N. Steen Krogh, None; T. Lottenburger, None; T. Ellingsen, None; L. Smedegaard Andersen, None; H. Skjødt, None; A. Svendsen, None; U. Tarp, None; I. Tønder Hansen, None; J. Pødenphant, None; J. K. Pedersen, None; H. Lindegaard, None; A. Vestergaard, None; D. Glinatsi, None; M. Østergaard, None.

To cite this abstract in AMA style:

Møller-Bisgaard S, Ejbjerg BJ, Eshed I, Hørslev-Petersen K, Lund Hetland M, Jurik AG, Thomsen HS, Torfing T, Stengaard-Pedersen K, Junker P, Steen Krogh N, Lottenburger T, Ellingsen T, Smedegaard Andersen L, Skjødt H, Svendsen A, Tarp U, Tønder Hansen I, Pødenphant J, Pedersen JK, Lindegaard H, Vestergaard A, Glinatsi D, Østergaard M. Magnetic Resonance Imaging (MRI) Joint Space Narrowing Is an Independent Predictor of Radiographic and MRI Damage Progression in Patients with Early Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/magnetic-resonance-imaging-mri-joint-space-narrowing-is-an-independent-predictor-of-radiographic-and-mri-damage-progression-in-patients-with-early-rheumatoid-arthritis/. Accessed .

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/magnetic-resonance-imaging-mri-joint-space-narrowing-is-an-independent-predictor-of-radiographic-and-mri-damage-progression-in-patients-with-early-rheumatoid-arthritis/