Background EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA) states that magnetic resonance imaging (MRI) bone oedema (osteitis) is a strong independent predictor of subsequent radiographic progression in early RA and should be considered for use as a prognostic indicator. The development of rapid radiographic progression (RRP) is considered as a representative poor outcome in patients with RA.
Objectives We have tried to examine the variables that predict the development of RRP in patients with early-stage RA from Nagasaki University Early Arthritis Cohort.
Methods This is a 1 year observational study from seventy-six early-stage RA patients recruited consecutively from Nagasaki University Early Arthritis Cohort in which the subjects received Gd-enhanced MRI of both wrists and finger joints. All of the patients had been received DMARDs during 1 year. MRI-proven osteitis was scored by Rheumatoid Arthritis Magnetic Resonance Imaging score (RAMRIS). Plain radiographic outcome of both wrists and finger joints was scored by Genant-modified Sharp score and the development of rapid radiographic progression (RRP) at 1 year in this study was identified as a score >3/year. The clinical response toward introduction of DMARDs at 3 months was defined according to DAS28-EULAR response criteria. Variables with a p value less than 0.20 were selected for the following multivariate logistic regression analyses. Starting with a full model, the most appropriate model was selected on the basis of Akaike's information criteria in the SAS system®, version 9.2.
Results Median age and disease duration at entry were 54.5 y.o and 3 months, respectively. The rate of ACPA-positive was 83%. Median RAMRIS osteitis score and that of Genant-modified Sharp score at entry were 1 and 0, respectively. RRP was developed in 12 patients at 1 year. Multivariate logistic regression analyses have identified that RAMRIS osteitis score at baseline (p=0.0009, Odds ratio 1.10, 95% CI 1.04-1.16) and the introduction of biologic DMARDs within 1 year (p=0.044, Odds ratio 5.46, 95% CI 1.05-28.57) are independent predictors toward the development of RRP at 1 year.
Conclusions Present data suggest that MRI-proven osteitis is closely associated with poor radiographic outcome in patients with early-stage RA. The use of biologic DMARDs may reflect the severe disease status.
Disclosure of Interest None declared
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