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Radiographic progression and remission rates in early rheumatoid arthritis – MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial
  1. Merete L Hetland1,
  2. Kristian Stengaard-Pedersen2,
  3. Peter Junker3,
  4. Mikkel Østergaard4,
  5. Bo J Ejbjerg1,
  6. Søren Jacobsen5,
  7. Tine Lottenburger4,
  8. Ib Hansen2,
  9. Ulrik Tarp2,
  10. Lis S Andersen4,
  11. Anders Svendsen4,
  12. Jens K Pedersen4,
  13. Ulrik B Lauridsen1,
  14. Torkell Ellingsen2,
  15. Hanne Lindegaard3,
  16. Jan Pødenphant6,
  17. Aage Vestergaard7,
  18. Anne Grethe Jurik8,
  19. Kim Hørslev-Petersen4,
  20. the CIMESTRA study group
  1. 1Department of Rheumatology, Copenhagen University Hospital, Hvidovre and Glostrup, Denmark
  2. 2Department of Rheumatology, Århus University Hospital, Århus, Denmark
  3. 3Department of Rheumatology, Odense University Hospital, Odense, Denmark
  4. 4Department of Rheumatology, Rheumatism Hospital, University of Southern Denmark, Gråsten, Denmark
  5. 5Department of Rheumatology, Rigshospitalet, Copenhagen University, Hvidovre, Denmark
  6. 6Department of Rheumatology, Copenhagen University Hospital Gentofte, Gentofte, Denmark
  7. 7Department of Radiology, Copenhagen University Hospital, Hvidovre, Denmark
  8. 8Department of Radiology, Århus University Hospital, Århus, Denmark
  1. Correspondence to Kim Hørslev-Petersen, Rheumatism Hospital, University of Southern Denmark, Toldbodgade 3, DK-6300 Gråsten, Denmark; khorslevpetersen{at}


Objective At 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome.

Methods 139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intra-articular betamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline.

Results At 5 years, TSS progression rate was <1 unit/year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years.

Conclusion Early and strict synovitis suppressive treatment with MTX and intra-articular GC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.

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  • Participants in the CIMESTRA study group are listed in the online supplementary file.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ref nr. M-1959-98.

  • Provenance and peer review Not commissioned; externally peer reviewed.