Abstract

Imaging remission has for several years played a key role in the clinical treatment surveillance and disease control in oncology, and as rheumatoid arthritis share several similarities to a local cancer, a similar strategy could potentially aid to obtain faster disease control and visualisation of local inflammation suppression than clinical measures alone.

An imaging guided remission strategy in patients with rheumatoid arthritis (RA) is supported in two recent reviews from 2012 and 2014, summing the latest findings in this field, where several studies, have shown that modern imaging, especially ultrasound and MRI can detect a relative large subgroup of RA patients in clinical remission who have subclinical inflammations, and that these patients subsequently have a high probability of continuous structural joint damage. These findings have already been acknowledged and included in the EULAR 2013 recommendations for the use of imaging of the joints in the management of RA, but it is still not known whether a more aggressive imaging guided treatment regime in these patients provides better disease control and prevention of structural joint progression than the treat-to-target approach where the cornerstone is fast step-up in both DMARDS and potential biologics guided by clinical measures. These questions are explored in several on-going randomized controlled multicentre studies.

Another potential important area for imaging guided remission control could be monitoring of discontinuation of biologic therapy, where a recent ultrasound study showed promising results regarding prediction of both flares and absent of flares, but we await more results from on-going studies.

Finally newer imaging modalities such whole-body MRI, dynamic contrast enhanced MRI, diffusion weighted MRI, and PET/SPECT CT-scans or combination of these are emerging and might also ad important information in the above mentioned areas.

The presentation is divided into 3 parts:

1. Current accepted and used remission criteria's

2. Recent studies using RAMRIS and Ultrasound remission criteria's - pros and cons

3. Future perspectives using novel promising imaging approaches like whole-body MRI, Dynamic contrast enhanced MRI (DCE-MRI), MR-Diffusion, PET and SPECT-CT