Background An international task force toward T2T suggests that drug therapy should be adjusted every 3 months until the desired treatment target is reached. EULAR recommendations for the use of imaging of joints in the clinical management of RA state that MRI is useful in monitoring disease activity. However, there are few clinical investigations searching whether MRI findings are even helpful to consider radiographic progression in RA patients achieved in sustained clinical good response.
Objectives To examine whether baseline MRI findings are useful to predict subsequent radiographic progression in early-stage RA patients who achieved in sustained clinical good response through T2T therapeutic strategy.
Methods This is a sub-analysis from the 1-year observational study from 76 early-stage RA patients recruited consecutively from Nagasaki University Early Arthritis Cohort in which subjects received Gd-enhanced MRI of both wrists and finger joints every 6 months. All patients had been received DMARDs during 1 year after entry and we have selected the 36 patients in which the favorable clinical response was obtained. The favorable clinical response was defined by decrement of DAS28 1.2 at 3 months as well as achievement of DAS28 low disease activity or remission at 6 months to 1 year. Synovitis, bone edema and bone erosion determined by Gd-enhanced MRI were scored by OMERACT-RAMRIS. Plain radiographic damages were scored by Genant-modified Sharp score. We have investigated whether baseline MRI findings are helpful to predict subsequent radiographic progression in these 36 good clinical responders.
Results Median age, disease duration were 55 y.o, 2.4 months and median DAS28-CRP, CRP (mg/dl), MMP-3 (ng/ml) were 4.4, 0.90 and 82.1, respectively. Rate of ACPA-positive and RF-positive were both 80%. Median RAMRIS synovitis, bone edema, bone erosion score and Genant-modified Sharp score at baseline were 8, 1.5, 0 and 0, respectively. Among the 36 good clinical responders, ten patients developed radiographic progression at 1 year (Δscore >0). Multivariate logistic regression analysis has identified that baseline RAMRIS bone erosion score (1 increase, Odds ratio 3.29, 95% C.I. 1.36-7.95) is the only independent predictor toward the development of plain radiographic progression at 1 year. In addition, cut-off point 1.5 of baseline MRI bone erosion score showed the best discriminative value toward plain radiographic progression (sensitivity 80.0%, specificity 84.6%).
Conclusions Our present data suggest that MRI bone erosion involves in poor radiographic outcome in patients with early-stage RA even successfully treated by T2T strategy. Physicians should pay attention to the presence of MRI bone erosion in these patients.
Disclosure of Interest None declared
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