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Magnetic resonance imaging assessed inflammation in the wrist is associated with patient-reported physical impairment, global assessment of disease activity and pain in early rheumatoid arthritis: longitudinal results from two randomised controlled trials
  1. Daniel Glinatsi1,
  2. Joshua F Baker2,
  3. Merete L Hetland1,3,
  4. Kim Hørslev-Petersen4,5,
  5. Bo J Ejbjerg6,
  6. Kristian Stengaard-Pedersen7,
  7. Peter Junker8,
  8. Torkell Ellingsen8,
  9. Hanne M Lindegaard8,
  10. Ib Hansen7,
  11. Tine Lottenburger9,
  12. Jakob M Møller10,
  13. Lykke Ørnbjerg1,
  14. Aage Vestergaard11,
  15. Anne Grethe Jurik7,12,
  16. Henrik S Thomsen3,10,
  17. Trine Torfing8,
  18. Signe Møller-Bisgaard1,
  19. Mette B Axelsen1,
  20. Mikkel Østergaard1,3
  1. 1Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Glostrup, Denmark
  2. 2Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
  3. 3Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  4. 4Deptartment of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Graasten, Denmark
  5. 5Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
  6. 6Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
  7. 7Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  8. 8Department of Rheumatology C, Odense University Hospital, Odense, Denmark
  9. 9Department of Medicine, Rheumatology, Vejle Hospital, SLB, Vejle, Denmark
  10. 10Department of Radiology, Copenhagen University Hospital Herlev, Herlev, Denmark
  11. 11Department of Radiology, Hvidovre University Hospital, Hvidovre, Denmark
  12. 12Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Daniel Glinatsi, Copenhagen Center for Arthritis research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, 5th entrance, Ndr. Ringvej 57, 2600 Glostrup, Denmark; daniel.glinatsi{at}


Objectives To examine whether MRI assessed inflammation and damage in the wrist of patients with early rheumatoid arthritis (RA) are associated with patient-reported outcomes (PROs).

Methods Wrist and hand MRIs of 210 patients with early RA from two investigator-initiated, randomised controlled studies (CIMESTRA/OPERA) were assessed according to the Outcome Measures in Rheumatology RA MRI score (RAMRIS) for synovitis, tenosynovitis, osteitis, bone erosions and joint space narrowing (JSN) at baseline, 1 and 5 years follow-up. These features, and changes therein, were assessed for associations with health assessment questionnaires (HAQ), patient global visual analogue scales (VAS-PtGlobal) and VAS-pain using Spearman’s correlations, generalised estimating equations and univariate/multivariable linear regression analyses. MRI features were further tested for trends against specific hand-related HAQ items using Jonckheere trend tests.

Results MRI inflammation, but not damage, showed statistically significant associations with HAQ, VAS-PtGlobal and VAS-pain for status and change scores, independently of C reactive protein and swollen joint count. MRI-assessed synovitis was most consistently associated with PROs, particularly VAS-PtGlobal and VAS-pain. MRI-assessed synovitis and tenosynovitis mean scores were positively associated with patient-reported difficulty to cut meat and open a milk carton (p<0.01), and similar patterns were seen for other hand-related HAQ items. Incorporating metacarpophalangeal joints in the analyses did not strengthen the associations between MRI pathology and PROs.

Conclusions MRI-assessed inflammation, but not damage, in early RA wrists is associated with patient-reported physical impairment, global assessment of disease activity and pain and influences the physical function in the hand.

Trial registration number NCT00660647.

  • MRI
  • early rheumatoid arthritis
  • inflammation

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  • Contributors Study concept and design: DG, JFB and MØ. Analysis and interpretation of data: DG, JBF and MØ. Drafting of the manuscript: DG. All authors were involved in the reviewing of the manuscript and approved the final version.

  • Funding CIMESTRA: the study was supported by a grant from The Danish Rheumatism Association and study medication was provided by Novartis Healthcare Denmark A/S, Nycomed, Schering-Plough and MSD. OPERA: the study was supported by grants from Abbot Laboratories and study medication was provided by Abbot Laboratories and Meda Pharmaceuticals.

  • Competing interests MLH: research support and grants from: BMS, AbbVie, Pfizer, UCB-Nordic, MSD and Biogen; consultation fees from: Orion, KH-P: consultation fees from: AbbVie and UCB, MBA: research support and grants from: AbbVie, MØ: consultation fees from: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB, Wyeth; research support and grants from: AbbVie, BMS, Janssen and Merck.

  • Ethics approval OPERA: The Regional Ethics Committee; CIMESTRA: The Ethics Committees of the participating counties.

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