Background Predictor for rapid radiographic progression (RRP) is still unknown. It has been reported that MRI osteitis is a strong independent predictor for radiographic joint damage (RJD) especially in early rheumatoid arthritis (RA) patients (1). Joint inflammation detected by MRI and ultrasound (US) is also a predictor for further RJD. It has been reported that MRI osteitis is associated with high grade US findings (2). However, little is known about the relationship between MRI osteitis, US inflammatory findings and RJD. Moreover, there has been no data to indicate MRI osteitis is essential for RRP in early or advanced RA patients.
Objectives (1) To investigate the relationship between MRI osteitis and US finding (2) To find association between MRI osteitis, US finding and RJD (3) To clarify MRI osteitis is associated with RRP in early or advanced RA.
Methods Twenty-nine RA patients with extensive MRI osteitis were further analyzed. Patients consist of 14 early RA below 36 month disease duration (mean 12.2±9.2 months) and 15 advanced RA above 37 months disease duration (mean86.9±58.9 months). Gd-enhanced MRI (0.3T) of affected hand were evaluated by the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS). We designated more than 10 osteitis score as extensive MRI osteitis. Joint erosion (JE) and joint space narrowing (JSN) score in both hands and feet by the conventional radiography (CR) were also evaluated by the modified total sharp score (m-TSS). Gray scale (GS) and power Dopper (PD) images of articular synovitis in metacarpophalngeal (MCP) and wrist joints were evaluated by the method proposed by EULAR. Data was expressed as the sum of the scores. Sperarman's correlation coefficient was used to investigate the correlation and Wilcoxon's rank sum test was used to compare continuous data.
Results Patient's demographics (mean) were as follows: age, 63 years old; disease duration, 50.8 months; male/female, 5/24; PSL dose, 0.9mg/day, anti-CCP antibody, 115.1U/ml; DAS28-ESR, 4.11; mTSS, 24 (5-194); ΔmTSS/year, 10.8 (0-53). Mean MRI osteitis and synovitis scores were 24.6 and 8.6, respectively. Mean US GS and PD scores were 10.8 and 5.0. Weak correlations were observed between MRI synovitis score and US PD score (r=0.36, p=0.06) and MRI osteitis score (r=0.31, p=0.10). ΔmTSS/year as index of RJD was only correlated with MRI osteitis (r=0.45, p=0.014). Finally, we compared the MRI osteitis score, ΔmTSS/year in early and advanced RA. As shown in the table, ΔmTSS/year in advanced RA was significantly less compared with that in early RA regardless of high osteitis score (p<0.0001). Percentage of RRP in early RA (14/14; 100%) was higher than that in advanced RA (2/15; 13.3%).
Conclusions Extensive MRI osteitis reflect RJD compared with MRI synovitis, US GS and PD's inflammatory findings. Extensive MRI osteitis is associated with RRP in early RA, but not in advanced RA.
Colebatch AN et al. Ann Rheum Dis 2013;72:804-814
Kawashiri S et al. Eular meeting 2013, abstract SAT 489
Disclosure of Interest None declared