MRI-detected subclinical joint inflammation is associated with radiographic progression
- A Krabben1,
- W Stomp2,
- J A B van Nies1,
- T W J Huizinga1,
- D van der Heijde1,
- J L Bloem2,
- M Reijnierse2,
- A H M van der Helm-van Mil1
- 1Department of Rheumatology, Leiden University Medical Center, The Netherlands
- 2Department of Radiology, Leiden University Medical Center, The Netherlands
- Correspondence to A Krabben, Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands;
- Received 8 January 2014
- Revised 31 May 2014
- Accepted 11 July 2014
- Published Online First 29 July 2014
Background We recently demonstrated that MRI inflammation is prevalent in clinically non-swollen joints of early arthritis patients. In this study, we assessed the relevance of this subclinical inflammation with regard to radiographic progression.
Methods 1130 joints (unilateral metacarpophalangeal 2–5, wrist and metatarsophalangeal 1–5) of 113 early arthritis patients underwent clinical examination and 1.5 T MRI at baseline, and radiographs at baseline and 1 year. Two readers scored the MRIs for synovitis, bone marrow oedema (BME) and tenosynovitis according to Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) Scoring System (RAMRIS). Radiographic progression over 1 year was determined using the Sharp–van der Heijde scoring method.
Results On patient level, BME, synovitis and tenosynovitis were associated with radiographic progression, independent of known risk factors (p=0.003, 0.001 and 0.011, respectively). Of all non-swollen joints (n=932), 232 joints (26%) had subclinical inflammation (≥1 MRI-inflammation feature present). These joints were distributed among 91% of patients. Radiographic progression was present in 4% of non-swollen joints with subclinical inflammation compared to 1% of non-swollen joints without subclinical inflammation (relative risks (RR) 3.5, 95% CI 1.3 to 9.6). Similar observations were done for BME (RR5.3, 95% CI 2.0 to 14.0), synovitis (RR3.4, 95% CI 1.2 to 9.3) and tenosynovitis (RR3.0, 95% CI 0.7 to 12.7) separately.
Conclusions Radiographic progression was infrequent, but joints with subclinical inflammation had an increased risk of radiographic progression within year 1. This demonstrates the relevance of MRI-detected subclinical inflammation.