Background Tapering and stopping DMARD treatment attracts growing interest due to the steady increase in rheumatoid arthritis (RA) patients achieving sustained disease remission. Since only a subset of RA patients in remission can successfully taper or stop these drugs, reliable predictors, which can help to identify patients with high risk for relapse, need to be detected. In the randomized controlled RETRO study1 we recently showed that a serum marker (MBDA) indicating residual inflammation was able to predict the relapse risk in the context of DMARD tapering2.
Objectives To test whether presence of residual inflammation in the magnetic resonance imaging (MRI) is associated with a higher relapse risk in RA patients tapering or stopping DMARD treatment.
Methods Baseline MRI scans were available from 55 patients of the randomized controlled RETRO study. All patients had RA (ACR/EULAR 2010 criteria) in sustained remission (DAS28 <2,6 for at least 6 months) with stable DMARD treatment for at least 6 months. Patients either continued on their DMARD regimen (Arm1), tapered it by 50% (Arm 2) or stopped it after a 6 month tapering phase (Arm3). Follow-up period was 12 months. MRI scans were scored for synovitis, osteitis and tenosynovitis according to RAMRIS and Haavardsholm scores3,4.
Results MRI synovitis was found in 58%, MRI osteitis in 26% and MRI tenosynovitis in 24% of the patients. Prevalence of baseline MRI changes did not differ between patients experiencing relapse of RA or remaining in remission (62% in both groups, p=0,981). Also, baseline MRI scores were not different between patients relapsing or not relapsing: Median (IQR) total RAMRIS scores in the relapse group were 9 (3,5–48) and in the non-relapse group 8 (2,75–14,5) (p=0,27), median synovitis scores were 3 (0–7) and 1 (0–6) (p=0,65), median osteitis scores 0 (0–0,25) and 0 (0–3,5) (p=0,48) and tenosynovitis scores 0 (0–0,25) and 0 (0–0,5) (p=0,82) respectively. Furthermore, MRI synovitis, osteitis and tenosynovitis scores were not different between ACPA+ than ACPA- individuals (p=0,80, 0,82, and 0,95, respectively).
Conclusions Subclinical MRI changes are frequent in RA patients in sustained remission but do not predict the risk of disease relapse during DMARD tapering.
Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy:interim results from the prospective randomized controlled RETRO study. Haschka J.et al. Ann Rheum Dis, 2015. Published online first 6 Feb 2015. doi:10.1136/annrheumdis-2014-206439
Prediction of disease relapses by multibiomarker disease activity and autoantibody status in patients with rheumatoid arthritis on tapering DMARD treatment. Rech J,et al. Ann Rheum Dis, 2015. Published online first 19 October 2015 doi:10.1136/annrheumdis-2015-207900
OMERACT rheumatoid arthritis magnetic resonance imaging studies.Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. Ostergaard M, et al. J Rheumatol 2003;30;1385–1386
Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis:reliability in a multireader longitudinal study. Haavardsholm EA, et al. Ann Rheum Dis 2007;66:1216–1220
Disclosure of Interest None declared