Studies investigating prediction of progression of joint erosions in patients with rheumatoid arthritis (RA) using baseline imaging parameters
| Association with erosion progression (radiographic or MRI) | ||||||
|---|---|---|---|---|---|---|
| Reference | Year | Study type | Description | MRI bone oedema | MRI synovitis | PDUS synovitis |
| Døhn 1 | 2010 | 1 | 52 patients with biologic-naive RA, disease duration 7 years, followed for 12 months on anti-TNF therapy (adalimumab/methotrexate) | Baseline: RR 3.8, p<0.001 | Baseline: RR 0.68, p=0.79 | Baseline: RR 7.5, p=0.06 |
| Ever: RR 14.8, p<0.0001 | Ever: RR 0.24, p=0.30 | Ever: RR 16.9, p=0.052 | ||||
| AUC score p<0.001 | AUC score p=0.063 | AUC score p=0.002 | ||||
| McQueen 6 | 2003 | 1 | 42 patients with early RA enrolled, disease duration ≤6 months. Full imaging data available for 31. Followed for 6 years on non-biologic DMARDs | Baseline bone oedema score was only MRI feature on multivariate analysis to predict 6-year Sharp score: R2=0.20, p =0.01. At each bone OR 6.5 (95% CI 2.78 to 18.1) for MRI erosion | Baseline score not predictive of 6-year Sharp score: R2=0.05, p=0.2. At each bone no association with later erosion, p=0.5 | Not included |
| Hetland 7 | 2009 | 2 | 130 patients with early RA, disease duration 3.3 years. Combination non-biologic DMARDs including ciclosporin or placebo. Followed for 2 years | Baseline bone oedema score was the only independent predictor of 2-year change in Sharp score (multivariate linear regression) coefficient=0.75 (95% CI 0.55 to 0.94), p=0.001 | Baseline synovitis score did not predict change in Sharp score. Coefficient = 0.20 (95% CI −0.09 to 0.48), p=0.17. No AUC analysis | Not included |
| Mundwiler 8 | 2009 | 1 | 50 patients with RA recruited; 46 had suitable data, disease duration <5 years. MRI and XR of MTP joints (3–5 bilaterally). Traditional and biologic DMARDs assessed at 12 and 24 months | Baseline bone oedema predicted MRI erosion: OR (6 months = 34.17; 12 months = 68.0). PPV 0.50, NPV 0.99 | Synovitis resolved in two-thirds of MTPs when present in isolation. No association with later MRI erosion reported | Not included |
| Naredo 4 | 2008 | 1 | 367 patients with RA, complete imaging data in 278. Disease duration 9.6 years. PDUS of 28 joints (shoulders, elbows, wrists, hands, knees). Followed for 12 months | Not included | Not included | Time-integrated values for PDUS signal and RF predicted XR erosion progression, R = 0.64 |
| Brown 10 | 2008 | 1 | 102 patients with RA in clinical remission treated with DMARDs, complete imaging data in 90. Disease duration 7 years. PDUS and MRI of dominant wrist and MCP joints | Prediction of structural deterioration in the MCP joints (OR 2.26, 95% CI 0.98 to 5.22, p=0.057) | Prediction of structural deterioration in the MCP joints (OR 2.98, 95% CI 1.49 to 5.97, p=0.002) | Prediction of structural deterioration in the MCP joints (OR 12.21, 95% CI 3.34 to 44.73, p<0.001) |
| Palosaari 9 | 2006 | 1 | 27 patients with early RA, disease duration ≤12 months, followed up for 1 year and 24 for 2 years with contrast-enhanced MRI | Bone oedema score only baseline variable to predict erosive progression at 2 years on multivariate regression (OR 4.2, 95% CI 1.3 to 13.8). At each bone, predicted erosion at 1 and 2 years: OR 28 (95% CI 11.7 to 67.1) and 14.9 (95% CI 6.3 to 34.9) | Synovitis score (baseline) only predictive of erosion at 2 years on univariate analysis; Spearman correlation coefficient=0.57, p=0.004 | Not included |
Study type: 1, observational, longitudinal; 2, randomised clinical trial.
AUC, area under the curve; DMARDs, disease-modifying antirheumatic drugs; MCP, metacarpophalangeal joint; MTP, metatarsophalangeal joint; NPV, negative predictive value; PDUS, power Doppler ultrasound; PPV, positive predictive value; RF, rheumatoid factor; RR, relative risk; XR, plain radiography.