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FRI0028 Gazing into the Crystal Ball? Prospective MRI Score to Predict Negative Eular-Response in Patients with Rheumatoid Arthritis (RA) Before Therapy-Escalation to a Biological Therapy
  1. P. Sewerin1,
  2. R. Brinks1,
  3. C. Schleich2,
  4. F. Miese2,
  5. S. Vordenbäumen1,
  6. S. Klein1,
  7. G. Antoch2,
  8. M. Schneider1,
  9. B. Ostendorf1
  1. 1Department for Rheumatology
  2. 2Department of Diagnostic and Interventional Radiology, University Hospital Duesseldorf, Düsseldorf, Germany

Abstract

Objectives To define and validate a new MRI score for the prediction of negative response in patients with rheumatoid arthritis (RA) before therapy-escalation to a biological therapy.

Methods Remission plus was a multicentre (n=11) German “real-life” MRI study with the aim to implement MRI in diagnostic and therapy-control in patients with RA. MRI was performed before therapy-escalation (T0) and after 12 month (T1) and were analysed by using the OMERACT rheumatoid arthritis MRI score (RAMRIS). In addition clinical and laboratory parameters (DAS-28 and CRP) were collected for each visit. The new MRI score was developed using a logistic regression and is a combination of the patients' age and the RAMRIS-T0 score. In the logistic regression we adjusted for possible confounders. Performance of the score is assessed in terms of area-under-the-curve (AUC). To validate the new score, a bootstrap analysis is performed with 5000 resamplings.

Results Overall 257 patients were investigated with MRI, while 29 (20 female, median age 57 (IQR 46 – 65) years, 95% anti-TNF-alpha therapy) of them were escalated to a biological therapy. Poor responders (n=5) and non-poor responders (n=24) had a mean RAMRIS-T0 score of 14.4 and 52.0, respectively (Wilcoxon test p<0.01). High RAMRIS-score seemed protective against non-response. The odds ratio for an increase of RAMRIS by one point was 0.90 (95% confidence interval 0.79-1.03, p=12%). The strength of the association was stable after adjusting for age, CCP, CRP, rheumatoid-factor (RF) and DAS28 at baseline. The median AUC in the bootstrap analysis is 88.9% with IQR 84.0-92.8%.

Conclusions RAMRIS-T0 possibly has the potential to predict poor EULAR-response in patients with RA before initiation of a biological therapy. By using the new score the predictive value was (AUC up to 95%) surprisingly high. Due to its high predictive value this score could be a possible tool in personalized medicine concepts after performing follow-up studies in clinical trials.

Disclosure of Interest None declared

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