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Abstract Number: 1042

Psoriatic Arthritis Patients Assessed by Dynamic Contrast-Enhanced MRI in High Disease Versus Minimal Disease Activity State – a Cross-Sectional Study Correlating Conventional MRI and Clinical Composite Measures

René Panduro Poggenborg1, Pernille Bøyesen2, Charlotte Wiell3, Susanne Juhl Pedersen4, Inge Juul Sørensen5, Ole Rintek Madsen6, Ole Slot1, Jakob M. Møller7, Mikael Boesen8, Henning Bliddal9, Olga Kubassova10 and Mikkel Østergaard11, 1Department of Rheumatology, Copenhagen University Hospital in Glostrup, Copenhagen, Denmark, 2Rheumatology, Diakonhjemmet Hospital, Olso, Norway, 3Department of Rheumatology, Copenhagen University Hospital in Gentofte, Copenhagen, Denmark, 4Department of Rheumatology, Copenhagen University Hospital Glostrup, Copenhagen, Denmark, 5Department of Rheumatology, Glostrup Hospital, Copenhagen, Denmark, 6DANBIO, On behalf of Depts of Rheumatology, North, South, Central, Zealand and Capital Region, Copenhagen, Denmark, 7Department of Radiology, Copenhagen University Hospital at Herlev, Copenhagen, Denmark, 8The Parker Institute, Department of Rheumatology, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark, 9The Parker Institute, Department of Rheumatology, Copenhagen University Hospital at Frederiksberg, Frederiksberg, Denmark, 10Image Analysis Ltd., Leeds, United Kingdom, 11Dept of Rheumatology RM, Glostrup Hospital, Glostrup, Denmark

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: imaging techniques, magnetic resonance imaging (MRI) and psoriatic arthritis

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Session Information

Session Title: Imaging of Rheumatic Diseases: Magnetic Resonance Imaging, Computed Tomography and X-ray

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) has been validated in rheumatoid arthritis for measuring inflammation, but has rarely been studied in psoriatic arthritis (PsA).

The purpose was to investigate whether DCE-MRI can discriminate PsA patients with high disease activity from minimal disease activity (MDA)(1), and to correlate DCE-MRI findings with conventional MRI and clinical measures.

Methods:

PsA patients fulfilling CASPAR criteria were eligible in this investigator-initiated study of patients with either high disease activity (group 1) or MDA (group 2). Inclusion criteria were for group 1: swollen joint count (SJC)≥6, tender joints count (TJC)≥6, hand involvement and clinical indication for initiation of anti-TNF therapy, and for group 2: hand involvement within 1 year, long-term treatment with adalimumab 40 mg eow, and fulfilling criteria for MDA (at least 5 out of 7: TJC≤1; SJC≤1; body surface area≤3%; PtGA≤20; pain≤15; HAQ≤0.5; 13-enthesitis≤1). DAS28 and the new Disease Activity index for PSoriatic Arthritis (DAPSA)(2) score (sum of SCJ, TJC, PtGA, pain and CRP) was calculated. The validated PsAMRIS scoring system (3) was used for analyzing conventional MRI (0.6 tesla). PsAMRIS total inflammation was calculated by adding synovitis, flexor tenosynovitis, periarticular inflammation and bone marrow oedema scores. DCE-MRI were analysed by Dynamika software (Image Analysis Ltd., Leeds, UK). Regions of interest (ROIs) were drawn around 2.-5. metacarpophalalangeal joints, excluding large blood vessels. The ROIs were used for automatic computing of the number of pixels with plateau and washout pattern (Np+w), the initial rate of enhancement (IRE), and maximum enhancement (ME).

Results:

Patient characteristics were: 9 males/8 females, median age 45 (25-63) years, joint/skin disease duration 8 (2-59)/15(2-59) years (no difference between groups). Clinical and imaging data are shown in the table. 

Group 1: High disease activity (n=9)

Group 2: Minimal Disease Activity (n=8)

P value

Np+w

712 (13-1587)

362 (25-1316)

0.25

IRE x 103

8 (5-33)

10 (6-14)

0.29

ME

1.20(1.17-1.33)

1.21 (1.16-1.33)

0.92

Np+w* IRE

5.4(0.4-15.9)

2.8 (0.2-13.2)

0.44

Np+w* ME

946(16-1903)

434 (29-1608)

0.29

PsAMRIS synovitis

3 (0-5)

2 (0-5)

0.59

PsAMRIS total inflammation

16 (1-24)

7.5 (3-18)

0.19

DAS28 score

5.5 (3.9-6.4)

1.4 (1.1-2.4)

0.01

DAPSA score

64.9 (30.9-103.3)

2.4 (0.1-5.6)

0.01

Median (range). Groups compared using Krustal-Wallis test.

We found a significant correlation between the DCE-MRI parameters (Np+w*IRE, Np+w*ME  and Np+w) and PsAMRIS total inflammation (Spearman’s rho: 0.53, 0.51 and 0.51; all P<0.05).  DCE-MRI parameters were not statistically significant correlated with clinical measures, but Np+w*IRE, Np+w*ME  and Np+wwere numerically lower in the MDA group.

Conclusion:

DCE-MRI parameters correlated significantly with PsAMRIS total inflammation score, and showed a trend toward higher values in the high disease activity versus the MDA group. DCE-MRI is a promising method for assessing joint inflammation in PsA. However, a larger longitudinal study is needed to clarify, if DCE-MRI is superior to conventional MRI for discriminating between disease activity levels.

Ref: 1. Coates, ARD 2009; 2. FitzGerald, ARD 2011; 3. Østergaard, JRheum 2009


Disclosure:

R. P. Poggenborg,

Abbott Laboratories,

5;

P. Bøyesen,
None;

C. Wiell,
None;

S. J. Pedersen,
None;

I. J. Sørensen,
None;

O. Rintek Madsen,
None;

O. Slot,
None;

J. M. Møller,
None;

M. Boesen,
None;

H. Bliddal,
None;

O. Kubassova,

Image Analysis Ltd.,

4;

M. Østergaard,
None.

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