title: Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state.
abstract: OBJECTIVE
  In rheumatoid arthritis (RA), radiographic progression may occur despite clinical remission. This may be explained by subclinical inflammation. Magnetic resonance imaging (MRI) provides a greater sensitivity than clinical examination and radiography for assessing disease activity. Our objective was to determine the MRI characteristics of RA patients in clinical remission or low disease activity (LDA) state.
  
  
  METHODS
  Databases from 6 cohorts were collected from 5 international centers. RA patients in clinical remission according to Disease Activity Score28-C-reactive protein (DAS28-CRP < 2.6; n = 213) or LDA-state (2.6 ≤ DAS28-CRP < 3.2; n = 81) with available MRI data were included. MRI were assessed according to the OMERACT RA MRI scoring system (RAMRIS).
  
  
  RESULTS
  
  
  
  METHODS
  70% women, median age 55 (interquartile range, IQR 43-63) years, disease duration 2.3 (IQR 0.7-5.1) years, DAS28-CRP 2.2 (IQR 1.8-2.6), Simplified Disease Activity Index, SDAI, 3.9 (IQR 1.9-6.5), Clinical Disease Activity Index, CDAI, 3.1 (IQR 1.5- 5.8), rheumatoid factor/anti-cyclic citrullinated peptide positivity 57%/54%, presence of radiographic erosions: 66%. Wrist and metacarpophalangeal MRI (MCP-MRI) data were available for 287 and 241 patients, respectively. MRI inflammatory activity in wrist and/or MCP joints was observed in the majority [synovitis: 95%, bone edema (osteitis): 35%] of patients. The median (IQR) RAMRIS score was 6 (3-9) for synovitis and 0 (0-2) for osteitis. Synovitis and osteitis were not less frequent in DAS28 clinical remission (synovitis/osteitis 96%/35%) than LDA (91/36). A trend towards lower frequencies of osteitis in patients in SDAI and CDAI remission was observed.
  
  
  CONCLUSIONS
  Subclinical inflammation was identified by MRI in the majority of RA patients in clinical remission or LDA state. This may explain structural progression in such patients. Further work is required to understand the place of modern imaging in future remission criteria.
authors: Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Paris 6-UPMC, Paris, France. frederique.gandjbakhch@psl.aphp.fr
authors: Frédérique
authors: F
authors: Gandjbakhch
authors: Philip G
authors: PG
authors: Conaghan
authors: Bo
authors: B
authors: Ejbjerg
authors: Espen A
authors: EA
authors: Haavardsholm
authors: Violaine
authors: V
authors: Foltz
authors: Andrew K
authors: AK
authors: Brown
authors: Uffe
authors: U
authors: Møller Døhn
authors: Marissa
authors: M
authors: Lassere
authors: Jane
authors: J
authors: Freeston
authors: Pernille
authors: P
authors: Bøyesen
authors: Paul
authors: P
authors: Bird
authors: Bruno
authors: B
authors: Fautrel
authors: Merete Lund
authors: ML
authors: Hetland
authors: Paul
authors: P
authors: Emery
authors: Pierre
authors: P
authors: Bourgeois
authors: Kim
authors: K
authors: Hørslev-Petersen
authors: Tore K
authors: TK
authors: Kvien
authors: Fiona
authors: F
authors: McQueen
authors: Mikkel
authors: M
authors: Ostergaard
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint / Q000473:pathology; D008875:Middle Aged; D010000:Osteitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D013585:Synovitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D014955:Wrist Joint / Q000473:pathology
chemical_list: D018501:Antirheumatic Agents