title: Advantages of a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and feet: does the RAMRIS of the hand alone underestimate disease activity and progression?
abstract: BACKGROUND
  To evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA).
  
  
  METHODS
  Magnetic resonance imaging (MRI, 0.2 Tesla) of the dominant hand and foot of 26 ACPA positive RA patients before and 6 months after initiation of methotrexate was obtained. RAMRIS of the hand was complemented by corresponding scoring of the foot (MTP I-V; HaF-score). Disease Activity Score 28 (DAS28) and a tender and swollen joint count (JC) of the joints scored in MRI were recorded. Changes in these scores (Δ) were assessed.
  
  
  RESULTS
  ΔHaF-score correlated significantly with ΔDAS28 (r = 0.820, 95%-CI 0.633-0.916). Correlations to ΔDAS28 were best for changes in the synovitis subscore (0.648) and bone marrow edema (0.703). Correlations to ΔDAS28 were significantly better for of the ΔHaF-score than ΔRAMRIS (0.499, 0.139-0.743, p = 0.0368).All patients with at least moderate response (EULAR criteria, n = 11) had continuing disease activity on MRI, including five cases with new erosions, three of them at the feet. Improvements of the hand JC or foot JC were seen in 16 and 15 cases, respectively. However, MRI of the hand or feet improved in only 10 and 9 cases, respectively. No patient fulfilled SDAI remission criteria.
  
  
  CONCLUSIONS
  The HaF-score identifies patients with continuing disease activity despite clinical response that would have been missed by consideration of the traditional RAMRIS or the DAS28 alone. Response as opposed to remission may be an insufficient goal in RA as all patients showed continuing disease activity, especially at the feet.
authors.affiliation: Department of Rheumatology, Univ Duesseldorf, Medical Faculty, Moorenstrasse 5, Duesseldorf D-40225, Germany. philipp.sewerin@med.uni-duesseldorf.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Sewerin
authors.forename: Christian
authors.initials: C
authors.lastname: Buchbender
authors.forename: Stefan
authors.initials: S
authors.lastname: Vordenbäumen
authors.forename: Axel
authors.initials: A
authors.lastname: Scherer
authors.forename: Falk
authors.initials: F
authors.lastname: Miese
authors.forename: Ralph
authors.initials: R
authors.lastname: Brinks
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Wittsack
authors.forename: Sabine
authors.initials: S
authors.lastname: Klein
authors.forename: Matthias
authors.initials: M
authors.lastname: Schneider
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.forename: Benedikt
authors.initials: B
authors.lastname: Ostendorf
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy / Q000473:pathology*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D018450:Disease Progression; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000473:pathology*; D006227:Hand Deformities, Acquired / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D002097:C-Reactive Protein; D008727:Methotrexate