title: Determining a magnetic resonance imaging inflammatory activity acceptable state without subsequent radiographic progression in rheumatoid arthritis: results from a followup MRI study of 254 patients in clinical remission or low disease activity.
abstract: OBJECTIVE
  To assess the predictive value of magnetic resonance imaging (MRI)-detected subclinical inflammation for subsequent radiographic progression in a longitudinal study of patients with rheumatoid arthritis (RA) in clinical remission or low disease activity (LDA), and to determine cutoffs for an MRI inflammatory activity acceptable state in RA in which radiographic progression rarely occurs.
  
  
  METHODS
  Patients with RA in clinical remission [28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6, n = 185] or LDA state (2.6 ≤ DAS28-CRP < 3.2, n = 69) with longitudinal MRI and radiographic data were included from 5 cohorts (4 international centers). MRI were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS). Statistical analyses included an underlying conditional logistic regression model stratified per cohort, with radiographic progression as dependent variable.
  
  
  RESULTS
  A total of 254 patients were included in the multivariate analyses. At baseline, synovitis was observed in 95% and osteitis in 49% of patients. Radiographic progression was observed in 60 patients (24%). RAMRIS synovitis was the only independent predictive factor in multivariate analysis. ROC analysis identified a cutoff value for baseline RAMRIS synovitis score of 5 (maximum possible score 21). Rheumatoid factor (RF) status yielded a significant interaction with synovitis (p value = 0.044). RF-positive patients with a RAMRIS synovitis score of > 5 vs ≤ 5, had an OR of 4.4 (95% CI 1.72-11.4) for radiographic progression.
  
  
  CONCLUSIONS
  High MRI synovitis score predicts radiographic progression in patients in clinical remission/LDA. A cutoff point for determining an MRI inflammatory activity acceptable state based on the RAMRIS synovitis score was established. Incorporating MRI in future remission criteria should be considered.
authors: From the Department of Rheumatology, Pitie Salpetriere Hospital, APHP, Université Paris 6-UPMC, Paris, France; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Hull York Medical School, University of York, York, UK; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; St. George Hospital, University of NSW, Sydney, Australia; King Christian X's Hospital for Rheumatic Diseases, University of Southern Denmark, Odense, Denmark; and Department of Molecular Medicine and Pathology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
authors: Frédérique
authors: F
authors: Gandjbakhch
authors: Espen A
authors: EA
authors: Haavardsholm
authors: Philip G
authors: PG
authors: Conaghan
authors: Bo
authors: B
authors: Ejbjerg
authors: Violaine
authors: V
authors: Foltz
authors: Andrew K
authors: AK
authors: Brown
authors: Uffe Møller
authors: UM
authors: Døhn
authors: Marissa
authors: M
authors: Lassere
authors: Jane E
authors: JE
authors: Freeston
authors: Inge Christoffer
authors: IC
authors: Olsen
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 M
authors: FM
authors: McQueen
authors: Mikkel
authors: M
authors: Østergaard
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D013585:Synovitis / Q000188:drug therapy / Q000473:pathology*
chemical_list: D018501:Antirheumatic Agents
keywords: LOW DISEASE ACTIVITY STATE; MAGNETIC RESONANCE IMAGING; REMISSION; RHEUMATOID ARTHRITIS