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).
|MRI variables||X-ray variables|
|MRI erosion||MRI JSN||MRI total damage score||X-ray erosion||X-ray JSN||TSS|
|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)
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 October 27, 2020.
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