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Editorial
Importance of ‘meeting of the minds’: patient-reported outcomes and MRI
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  1. Veena K Ranganath1,
  2. Vibeke Strand2
  1. 1University of California, Los Angeles, California, David Geffen School of Medicine, Los Angeles, California, USA
  2. 2Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
  1. Correspondence to Dr Veena K Ranganath, Division of Rheumatology, UCLA, 1000 Veteran Ave, Rehabilitation Building, Rm# 32-59, Los Angeles, CA 90095, USA; vranganath{at}mednet.ucla.edu

https://doi.org/10.1136/annrheumdis-2016-210058

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    Patient reported outcomes (PROs) are essential to the judicious care of patients with rheumatoid arthritis (RA). Rheumatologists were pioneers in this field with the first papers using PROs published in the 1940s.1 Exploring the link between PROs, which are potentially subjective, and the more objective radiographic or MRI measures of structural damage and joint inflammation is important. The former describe the patient experience, which is after all the point of clinical medicine, while the latter provide information about the disease process itself, which can be influenced by clinicians using modern therapeutic approaches. The recent paper published by Baker et al2 highlights a critical demonstration that inhibition of inflammation and progression of structural damage directly impacts reported pain of patients with RA and physical function, and positively influences their assessment of disease activity. This publication is one of several thought-provoking post hoc analyses performed within the MRI substudies of the Golimumab Before Employing Methotrexate as the First-Line Option in the Treatment of Rheumatoid Arthritis of Early Onset (GO-BEFORE) and Golimumab in Active Rheumatoid Arthritis Despite Methotrexate Therapy trials.3–6

    Evidence of the association between radiographic damage and PROs

    The first meta-analyses to examine the link between physical function and radiographic damage were published in 2000 and 2003.7 ,8 These studies were performed in the prebiologic era, where even small cross-sectional cohort studies demonstrated an association between total radiographic damage and the health assessment questionnaire-disability index (HAQ-DI). A subsequent comprehensive literature review of publications between 1990 and 2008 (including some postbiologic disease modifying antirheumatic drugs (DMARD) trials) eliminated cross-sectional studies9 and provided a synopsis of four key concepts regarding the relationship between structural damage and HAQ: (A) 9/19 randomised controlled trials (RCTs) demonstrated a significant relationship between baseline radiographic damage and end of study HAQ, (B) 10/19 showed significant correlations cross-sectionally across the entire trial duration; …

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