Background/Purpose: Background:

There are two types of remission in rheumatoid arthritis. The first, and most commonly applied, is clinical remission. Imaging remission is another aspect to consider given that (a) the correlation between clinical and imaging at presentation is only modest, (b) imaging can show subclinical inflammation not evident clinically and (c) imaging evidence of inflammation can predict structural damage. In this study, we compared clinical and imaging remission in early rheumatoid arthritis (ERA) patients after one year of standard treatment.

Objective:

To semi-quantitatively and quantitatively measure the degree of inflammation (synovitis, tenosynovitis, bone marrow oedema) and structural change (erosions, joint space narrowing) on MRI in early RA patients following treat-to-target strategy treatment for one year and to compare this with change in clinical parameters.

Methods: Prospective cross-sectional study of 70 ERA patients underwent treat-to-target strategy treatment for one year. DAS28-ESR remission (DAS28-ESR score < 2.6), 2011 ACR/EULAR definition of remission, SDAI remission (SDAI ≤ 3.3) and Boolean remission was measured before and after treatment. High resolution MRI of the most symptomatic wrist was performed before and after treatment. MRI parameters including RAMRS subscores, synovial volume (synovitis and tenosynovitis), synovial perfusion (max enhancement, enhancement slope) were measured. 

Results: 55 (79%) out of 70 ERA patients completed baseline and one-year clinical and MRI assessments. Remission rates for DAS28-ESR, SDAI and Boolean were 60% (33), 44% (24) and 33% (18) respectively. Eight (24%) out of 33 patients with DAS28-ESR remission, showed progression in bone erosion.  Four (17%) of 24 patients with SDAI remission showed progression in bone erosion while 1 (5 %) of 18 patients with Boolean remission showed progression in bone erosion. Patients who achieved remission after treatment had a greater reduction in MRI-evident inflammation as well as bone erosion. At month 12, MRI-evident joint synovitis, tenosynovitis and bone marrow oedema was still frequently seen in ERA patients with clinical remission though patients who achieved Boolean remission had the lowest levels of joint synovitis, bone marrow oedema as well as bone erosion for all patients at one year.

Conclusion: MRI detected inflammation is common even in patients with clinical remission. Patients with Boolean remission had less residual inflammation than DAS28-ESR or SDAI remission patients. Treat to target protocols should ideally target Boolean remission.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mri-of-the-wrist-in-early-rheumatoid-arthritis-after-1-year-treat-to-target-strategy/