Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose The joint involvement in psoriatic arthritis (PsA) is heterogeneous, and inflammation is seen in both axial and peripheral joints, including the small joints of the hands and feet. The quickly evolving treatment options increase the requirements for developing efficient measures for assessing the treatment response. MRI can visualize the inflammatory components of PsA as well as features reflecting bone damage. The objective of this randomized controlled trial (RCT) was to assess the course during treatment, reliability and responsiveness to change of the Psoriatic Arthritis Magnetic Resonance Imaging Score (PsAMRIS) in hand and foot.
Methods Forty PsA patients randomized to either placebo or abatacept in an RCT had MRI of either a single hand (n=20; all MCP, PIP and DIP joints) or foot (n=20; all MTP joints and the 1st interphalangeal joint) at baseline and after 6 months. Axial, T1-weighted, pre-contrast images, axial and coronal 3D post-contrast fat suppressed images, coronal and sagittal fat suppressed T2-weighted images and coronal short-tau inversion recovery (STIR) images were acquired. Images were scored blindedly, twice, by 3 readers according to the OMERACT PsAMRIS (synovitis, tenosynovitis, periarticular inflammation, bone oedema, bone erosion and bone proliferation). Change over time was assessed using Wilcoxon signed-rank test. Smallest detectable change (SDC) and intraclass correlation coefficient (ICC) were used for assessment of intrareader (single measure; SmICC) and interreader (average measure; AvmICC) reliability.
Results Inflammatory features improved numerically but non-significantly in the abatacept group but not the placebo group (table 1). Baseline intrareader intraclass correlation coefficients (ICC) for all features were good (³0.50) to very good (³0.80) for all or some readers in hand and foot. Baseline interreader ICC was good (ICC 0.72-0.96) for all features, except periarticular inflammation and bone proliferation in the hand and tenosynovitis in the foot (ICC 0.25-0.44). Intra- and interreader ICC for change scores varied. SDC was overall low (table 2). Guyatt’s responsiveness index (GRI) was high for inflammatory features in the hand and metatarsophalangeal joints of the foot (GRI 0.67-3.13) (bone oedema not calculable). Minimal change and low prevalence may explain low ICC and GRI for bone damage.
Conclusion PsAMRIS showed overall good intrareader agreement in the hand and foot and the inflammatory features were responsive to change, suggesting that PsAMRIS is a valid tool for MRI assessment of hands and feet in PsA clinical trials.
Table 1
|
HAND |
Total scores, mean (range) |
|||
|
Placebo |
Abatacept |
|||
|
PsAMRIS features (Range of total score) |
Baseline |
Change |
Baseline |
Change |
|
Synovitis (0-42) |
7.2 (6.0 to 9.1) |
-0.2 (-0.2 to -0.2) |
7.1 (5.6 to 9.1) |
-1.3 (-3.1 to 0.0) |
|
Flexor tenosynovitis (0-42) |
3.1 (2.1 to 4.8)
|
0.1 (-0.4 to 0.6) |
3.7 (2.8 to 4.2) |
-1.4 (-2.2 to -0.5) |
|
Periarticular inflammation (0-28) |
0.0 (0.0 to 0.1) |
0.0 (0.0 to 0.0) |
1.5 (0.5 to 3.3) |
-0.8 (-1.8 to -0.2) |
|
Bone oedema (0-84) |
0.3 (0.1 to 0.7) |
0.0 (0.0 to 0.0) |
1.9 (1.1 to 2.8) |
-0.5 (-0.7 to -0.4) |
|
Bone erosion (0-280) |
0.9 (0.7 to 1.1) |
-0.1 (-0.4 to 0.0) |
2.5 (1.8 to 2.9) |
0.0 (0.0 to 0.0) |
|
Bone proliferation (0-14) |
0.2 (0.0 to 0.3) |
0.0 (-0.1 to 0.0) |
0.5 (0.1 to 0.8) |
0.0 (-0.1 to 0.0) |
|
HAND |
Total scores |
|||
|
Placebo |
Abatacept |
|||
|
PsAMRIS features (Range of total score) |
Baseline |
Change |
Baseline |
Change |
|
Synovitis (0-18) |
2.6 (1.8 to 3.3) |
0.4 (0.0 to 0.8) |
5.4 (4.8 to 6.1) |
-1.2 (-1.3 to -1.1) |
|
Flexor tenosynovitis (0-18) |
0.4 (0.1 to 0.7) |
0.6 (0.3 to 0.8) |
1.0 (0.5 to 1.7) |
-0.1 (-0.7 to 0.6) |
|
Periarticular inflammation (0-12) |
0.1 (0.0 to 0.2) |
0.1 (0.0 to 0.2) |
1.5 (0.3 to 2.1) |
-0.3 (-0.4 to -0.1) |
|
Bone oedema (0-36) |
0.7 (0.3 to 0.9) |
0.0 (0.0 to 0.0) |
2.9 (2.5 to 3.1) |
-0.5 (-0.9 to -0.1) |
|
Bone erosion (0-120) |
1.3 (0.9 to 1.5) |
0.0 (-0.1 to 0.0) |
3.3 (2.3 to 5.0) |
0.0 (-0.1 to 0.1) |
|
Bone proliferation (0-6) |
0.5 (0.2 to 0.8) |
0.0 (-0.1 to 0.0) |
0.2 (0.1 to 0.3) |
0.0 (0.0 to 0.0) |
Table 2
|
HAND |
Intrareader |
Interreader |
||||
|
PsAMRIS features |
Baseline SmICC Range reader 1 to 3 |
Change SmICC Range reader 1 to 3 |
Change SDC Range reader 1 to 3 |
Baseline AvmICC |
Change AvmICC |
Change SDC |
|
Synovitis |
0.30 to 0.75 |
0.06 to 0.66 |
1.7 to 5.5 |
0.72 |
0.41 |
2.9 |
|
Flexor tenosynovitis |
0.69 to 0.89 |
0.78 to 0.88 |
2.2 to 2.6 |
0.92 |
0.87 |
1.9 |
|
Periarticular inflammation |
0.74 to 1.00 |
0.22 to 0.85 |
0.4 to 5.8 |
0.37 |
0.12 |
1.8 |
|
Bone marrow oedema |
0.60 to 0.95 |
-0.06 to 0.72 |
1.5 to 2.9 |
0.84 |
0.81 |
0.8 |
|
Bone erosion |
0.67 to 0.94 |
-0.06 to 0.04 |
0.0 to 1.4 |
0.90 |
0.23 |
0.4 |
|
Bone proliferation |
0.00 to 0.75 |
0.0 to 0.3 |
0.25 |
0.06 |
0.2 |
|
|
FOOT |
Intrareader |
Interreader |
||||
|
PsAMRIS features |
Baseline SmICC Range reader 1 to 3 |
Change SmICC Range reader 1 to 3 |
Change SDC Range reader 1 to 3 |
Baseline AvmICC |
Change AvmICC |
Change SDC |
|
Synovitis |
0.70 to 0.77 |
0.19 to 0.90 |
1.7 to 2.9 |
0.90 |
0.72 |
1.7 |
|
Flexor tenosynovitis |
0.42 to 0.74 |
0.42 to 0.79 |
0.8 to 2.4 |
0.44 |
0.40 |
1.6 |
|
Periarticular inflammation |
0.14 to 0.60 |
0.00 to 0.38 |
0.6 to 2.5 |
0.76 |
0.77 |
0.8 |
|
Bone marrow oedema |
0.70 to 0.96 |
-0.04 to 0.38 |
2.3 to 4.0 |
0.96 |
0.75 |
1.0 |
|
Bone erosion |
0.75 to 0.97 |
-0.02 to 0.75 |
0.3 to 1.6 |
0.73 |
0.30 |
0.7 |
|
Bone proliferation |
-0.15 to 0.59 |
NA/0.00 |
0.0 to 0.3 |
0.50 |
0.07 |
0.1 |
Disclosure:
D. Malm,
None;
P. Bird,
Abbvie,
8,
Pfizer Inc,
8,
Roche Pharmaceuticals,
8,
Celgene,
8,
Janssen Pharmaceutica Product, L.P.,
8,
UCB,
8;
F. Gandjbakhch,
None;
P. J. Mease,
Research grants from AbbVie, Amgen, Biogen Idec, BMS, Celgene, Crescendo, Janssen, Lilly, Merck, Novartis, Pfizer, UCB, and Vertex,
2,
AbbVie, Amgen, Biogen Idec, BMS, Celgene, Covagen, Crescendo, Janssen, Lilly, Merck, Novartis, Pfizer, UCB, and Vertex,
5,
AbbVie, Amgen, Biogen Idec, BMS, Crescendo, Janssen, Lilly, Pfizer, and UCB ,
8;
P. Bøyesen,
None;
M. Østergaard,
Abbott/Abbvie, Centocor, Merck, Schering-Plough,
2,
Abbott/Abbvie, BMS, Boehringer-Ingelheim, Eli-Lilly, Centocor, GSK, Janssen, Merck, Mundipharma, Novo, Pfizer, Schering-Plough, Roche UCB, and Wyeth,
5;
C. G. Peterfy,
Spire Sciences In.,,
1,
AbbVie, Inc., Amgen Inc., Articulinx, AstraZeneca, Bristol-Myers Squibb, Five Prime Therapeutics, Genentech, Hoffmann-La Roche, Inc., Lilly USA, LLC., Medimmune, Merck Pharmaceuticals, Moximed, Novartis Pharmaceuticals Corporation, Novo Nordisk, Plexxikon,
5,
Amgen,
8;
P. G. Conaghan,
Abbvie,
8,
Merck Pharmaceuticals,
8,
Novartis Pharmaceutical Corporation,
8,
Pfizer Inc,
8,
Roche Pharmaceuticals,
8,
UCB,
8,
Abbvie,
5,
Merck Pharmaceuticals,
5,
Novartis Pharmaceutical Corporation,
5,
Pfizer Inc,
5,
UCB,
5,
Roche Pharmaceuticals,
5.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-of-the-omeract-psoriatic-arthritis-magnetic-resonance-imaging-score-for-the-hand-and-foot-in-a-randomized-placebo-controlled-trial/