Background Rapid radiographic progression (RRP) has occurred in some rheumatoid arthritis (RA) patients regardless of any type of biological therapy. However, early diagnosis of RRP is still unknown.
Objectives The aim of this study is to find predictive MRI findings for RRP in RA patients.
Methods Twenty two RA patients, who treated for 1 year with Adalimumab (ADA) and methotrexate (MTX) combination therapy, were examined by radiography for both hands and feet using total Sharp-van der Heijde scoring (SHS) and compact MRI for both hands using cMRI score (cMRIS) (1) in low field MRI (0.3T) at baseline and 1 year after treatment. We analyzed to find the relationship between MRI and radiographic findings compared with RRP (SHS/y≥3) and non RRP (SHS/y <3) group.
Results Patients baseline demographics were: mean age: 60.1 year; RA disease duration: 8.4 year; baseline DAS28(ESR): 6.28; estimated ΔSHS/y: 13.7/y and HAQ-DI:1.9. At 1 year, 60.9% of patients achieved radiographic remission (ΔSHS/y <0.5) and ΔSHS/y was -0.5 (ΔJSN/y: 0.96, ΔJEN/y: -1.54). The cMRI showed 46.8%, 70.9%, 22.7% and 39.8% improvement of cMRISsynovitis, cMRISoedema, cMRISerosion and cMRISerosion + synovitis + oedema, respectively. Three patients were assessed for RRP group (n=3, SHS=6, 8 and 17, mean: 10.3). Other patients were assessed for non RRP group (n=19, -9≤SHS≤2: mean: -2.1). Radiographically, there were significant differences between two groups in ΔSHS/y and ΔJEN/y, (P<0.01). In MRI, significant increase of cMRISoedema at baseline (P<0.05), cMRISoedema at 1 year (P<0.01) and significant decrease of percentage improvement of cMRISoedema (P<0.01), cMRISsynovitis (P<0.05), cMRISerosion + synovitis + oedema (P<0.05) were observed in RRP group compared with non RRP group. These results showed that at baseline, bone marrow oedema in MRI was more predictive than synovitis (P=0.80, NS) or bone erosion (P=0.51, NS) as previously reported (2), and perpetuation of bone marrow edema was important for RRP at 1year.
Conclusions In low field MRI, bone marrow oedema was more associated with occurrence of RRP than synovitis or bone erosion in bio-naïve RA patients during ADA and MTX combination therapy.
T.Suzuki et al. A new low-field extremity magnetic resonance imaging and proposed compact MRI score: evaluation of anti-tumor necrosis factor biologics on rheumatoid arthritis. Mod.Rheumatol. 2009: 19. 358-365
F.Gandjbakhen et al. Bone marrow oedema predicts structual progression in 1-year follow up of 85 patients with RA in remission or with low disease activity with low-field MRI. Ann.Rheum.Dis.2011:70.2159-2162
Disclosure of Interest None Declared
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