title: Magnetic resonance imaging in rheumatoid arthritis clinical trials: emerging patterns based on recent experience.
abstract: OBJECTIVE
  The current validated magnetic resonance imaging (MRI) scoring method for rheumatoid arthritis (RA) in clinical trials, RA MRI Score (RAMRIS), incorporates all metacarpophalangeal (MCP) and wrist joints except MCP-1. The experience with radiographic scoring, however, was that excluding certain bones in the wrist improved the discriminative power for changes over time. In this study, we pool MRI data from randomized controlled clinical trails (RCT) to determine which combination of MCP and wrist joints are most sensitive and discriminative for structural changes over time.
  
  
  METHODS
  MR images from 4 multicenter RCT, including 522 RA patients, were read by 2 radiologists, using the RAMRIS scoring system for erosion, osteitis, and synovitis. In one RCT, joint-space narrowing (JSN) was assessed cross-sectionally by one radiologist using a previously validated method. Baseline frequencies of erosion, JSN, osteitis, and synovitis of different bones and joints in the hand and wrist were compared. Intraclass correlation coefficients between readers were determined for each location. Finally, 7 different combinations of bone/joint locations were compared for their ability to discriminate subjects showing increases or decreases from baseline greater than or equal to smallest detectable changes (SDC) at Weeks 12 or 24.
  
  
  RESULTS
  Frequency of involvement and reliability for assessing change varied by location. As in earlier analyses, excluding certain wrist bones increased the percentage of subjects showing changes greater than or equal to SDC.
  
  
  CONCLUSIONS
  These findings suggest that excluding wrist bones that do not frequently or reliably demonstrate structural changes improves the discriminative power of the RAMRIS scoring system.
authors: Spire Sciences, LLC, San Francisco, CA, USA. Charles.peterfy@spiresciences.com
authors: Charles G
authors: CG
authors: Peterfy
authors: Peter
authors: P
authors: Countryman
authors: Annarita
authors: A
authors: Gabriele
authors: Tim
authors: T
authors: Shaw
authors: Andrew
authors: A
authors: Anisfeld
authors: Wayne
authors: W
authors: Tsuji
authors: Ewa
authors: E
authors: Olech
authors: Norman B
authors: NB
authors: Gaylis
authors: Philip G
authors: PG
authors: Conaghan
authors: Vibeke
authors: V
authors: Strand
authors: Julie
authors: J
authors: Dicarlo
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008662:Metacarpophalangeal Joint / Q000473:pathology; D015337:Multicenter Studies as Topic / Q000379:methods; D010000:Osteitis / Q000175:diagnosis / Q000473:pathology; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013585:Synovitis / Q000175:diagnosis / Q000473:pathology; D014955:Wrist Joint / Q000473:pathology