Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Given the improved detection of joint injury by MRI than by clinical examination, EULAR recommendations for the use of imaging of the joints in the clinical management of RA states that MRI is useful in monitoring disease activity. However, there are few clinical investigations searching whether MRI findings are even helpful to consider radiographic progression in RA patients who achieved in sustained clinical good response. The present study is to examine whether MRI findings at baseline are useful to predict subsequent radiographic progression in early-stage RA patients who achieves in sustained clinical good response.
Methods: This is a sub-analysis from the 1-year observational study from 76 early-stage RA patients recruited consecutively from Nagasaki University Early Arthritis Cohort in which the subjects received Gd-enhanced MRI of both wrists and finger joints. They gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University. All patients had been received DMARDs during 1 year after entry. The sustained clinical good response was defined by decrement of DAS28 ≥1.2 at 3 months as well as achievement of DAS28 remission through 6 months to 1 year. Synovitis, bone oedema and bone erosion determined by Gd-enhanced MRI were scored by OMERACT-RAMRIS. Plain radiographic damage was studied by Genant-modified Sharp score and the radiographic progression was defined as Δ progression > 0 at 1 year (Δ score > 0). We have investigated whether MRI findings are helpful to predict subsequent radiographic progression in the sustained clinical good responders.
Results: Twenty-four patients were classified as sustained clinical good responders and examined in the present study. Median age, disease duration were 56 y.o, 2.0 months and median DAS28-CRP, CRP (mg/dl), MMP-3 (ng/ml) were 4.40, 0.52 and 87.2, respectively. Rate of ACPA-positive and RF-positive were 91.7 and 83.3%. Median RAMRIS synovitis, bone edema, bone erosion score and Genant-modified Sharp score at baseline were 6, 0.5, 0 and 0, respectively. Among the 24 sustained clinical good responders, five patients developed radiographic progression at 1 year. Multivariate logistic regression analysis has identified that baseline RAMRIS bone erosion score (1 increase, Odds ratio 3.00, 95% C.I. 1.10-8.20�, p-value 0.032) is the only independent predictor toward the development of radiographic progression at 1 year. In addition, cut-off point 0.5 of baseline MRI bone erosion score showed the best discriminative value toward radiographic progression (sensitivity 100.0%, specificity 73.7%).
Conclusion: Our present data suggest that MRI bone erosion involves in subsequent radiographic progression of early-stage RA even successfully treated by treating RA to target (T2T) strategy. Physicians are recommended to pay attention to the presence of MRI bone erosion in these patients.
To cite this abstract in AMA style:Tamai M, Nakashima Y, Arima K, Kita J, Umeda M, Fukui S, Nishino A, Suzuki T, Horai Y, Okada A, Koga T, Kawashiri SY, Iwamoto N, Ichinose K, Yamasaki S, Nakamura H, Origuchi T, Aoyagi K, Uetani M, Eguchi K, Kawakami A. MRI Bone Erosion at Baseline Predicts the Subsequent Radiographic Progression in Early-Stage RA Patients Who Achieved in Sustained Clinical Good Response: Sub-Analysis from Nagasaki University Early Arthritis Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/mri-bone-erosion-at-baseline-predicts-the-subsequent-radiographic-progression-in-early-stage-ra-patients-who-achieved-in-sustained-clinical-good-response-sub-analysis-from-nagasaki-university-early-a/. Accessed October 15, 2019.
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