title: Association of bone edema with the progression of bone erosions quantified by hand magnetic resonance imaging in patients with rheumatoid arthritis in remission.
abstract: OBJECTIVE
  To evaluate the association of synovitis, bone marrow edema (BME), and tenosynovitis in the progression of erosions quantified by hand magnetic resonance imaging (MRI) at 1 year in patients with early rheumatoid arthritis (RA) in remission.
  
  
  METHODS
  A total of 56 of 196 patients with early RA in remission at 1 year and with available MRI data at baseline and at 12 months were included. MRI images were assessed according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Persistent remission was defined as 28-joint Disease Activity Score-erythrocyte sedimentation rate ≤ 2.6 and/or Simplified Disease Activity Index ≤ 3.3 and/or the new boolean American College of Rheumatology/European League Against Rheumatism remission criteria for a continuous period of at least 6 months. Progression of bone erosions was defined as an increase of 1 or more units in annual RAMRIS score for erosions compared to baseline.
  
  
  RESULTS
  At 1 year, the majority of patients with RA in sustained remission showed some inflammatory activity on MRI (94.6% synovitis, 46.4% BME, and 58.9% tenosynovitis) and 19 of the 56 patients (33.9%) showed MRI progression of bone erosions. A significant difference was observed in MRI BME at 1 year, with higher mean score in patients with progression compared to nonprogression of erosions (4.8 ± 5.6 and 1.4 ± 2.6, p = 0.03).
  
  
  CONCLUSIONS
  Subclinical inflammation was identified by MRI in 96.4% of patients with RA in sustained clinical remission. Significantly higher scores of BME after sustained remission were observed in patients with progression of erosions compared to patients with no progression. The persistence of higher scores of BME may explain the progression of bone erosions in patients with persistent clinical remission.
authors.affiliation: From the Department of Rheumatology, and the Department of Radiology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona, Barcelona, Spain.M.P. Lisbona, MD; A. Pàmies, MD, Department of Rheumatology; J. Ares, MD, Department of Radiology; M. Almirall, MD, Department of Rheumatology; M. Navallas, MD; A. Solano, MD, Department of Radiology; J. Maymó, MD, Department of Rheumatology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona. 95179@parcdesalutmar.cat.
authors.forename: Maria Pilar
authors.initials: MP
authors.lastname: Lisbona
authors.affiliation: From the Department of Rheumatology, and the Department of Radiology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona, Barcelona, Spain.M.P. Lisbona, MD; A. Pàmies, MD, Department of Rheumatology; J. Ares, MD, Department of Radiology; M. Almirall, MD, Department of Rheumatology; M. Navallas, MD; A. Solano, MD, Department of Radiology; J. Maymó, MD, Department of Rheumatology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona.
authors.forename: Anna
authors.initials: A
authors.lastname: Pàmies
authors.affiliation: From the Department of Rheumatology, and the Department of Radiology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona, Barcelona, Spain.M.P. Lisbona, MD; A. Pàmies, MD, Department of Rheumatology; J. Ares, MD, Department of Radiology; M. Almirall, MD, Department of Rheumatology; M. Navallas, MD; A. Solano, MD, Department of Radiology; J. Maymó, MD, Department of Rheumatology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona.
authors.forename: Jesús
authors.initials: J
authors.lastname: Ares
authors.affiliation: From the Department of Rheumatology, and the Department of Radiology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona, Barcelona, Spain.M.P. Lisbona, MD; A. Pàmies, MD, Department of Rheumatology; J. Ares, MD, Department of Radiology; M. Almirall, MD, Department of Rheumatology; M. Navallas, MD; A. Solano, MD, Department of Radiology; J. Maymó, MD, Department of Rheumatology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona.
authors.forename: Miriam
authors.initials: M
authors.lastname: Almirall
authors.affiliation: From the Department of Rheumatology, and the Department of Radiology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona, Barcelona, Spain.M.P. Lisbona, MD; A. Pàmies, MD, Department of Rheumatology; J. Ares, MD, Department of Radiology; M. Almirall, MD, Department of Rheumatology; M. Navallas, MD; A. Solano, MD, Department of Radiology; J. Maymó, MD, Department of Rheumatology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona.
authors.forename: Maria
authors.initials: M
authors.lastname: Navallas
authors.affiliation: From the Department of Rheumatology, and the Department of Radiology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona, Barcelona, Spain.M.P. Lisbona, MD; A. Pàmies, MD, Department of Rheumatology; J. Ares, MD, Department of Radiology; M. Almirall, MD, Department of Rheumatology; M. Navallas, MD; A. Solano, MD, Department of Radiology; J. Maymó, MD, Department of Rheumatology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona.
authors.forename: Albert
authors.initials: A
authors.lastname: Solano
authors.affiliation: From the Department of Rheumatology, and the Department of Radiology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona, Barcelona, Spain.M.P. Lisbona, MD; A. Pàmies, MD, Department of Rheumatology; J. Ares, MD, Department of Radiology; M. Almirall, MD, Department of Rheumatology; M. Navallas, MD; A. Solano, MD, Department of Radiology; J. Maymó, MD, Department of Rheumatology, Hospital del Mar, Parc de Salut Mar, Universidad Autónoma de Barcelona.
authors.forename: Joan
authors.initials: J
authors.lastname: Maymó
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D001799:Blood Sedimentation; D001847:Bone Diseases / Q000175:diagnosis / Q000473:pathology*; D004185:Disability Evaluation; D018450:Disease Progression; D004487:Edema / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013585:Synovitis / Q000175:diagnosis / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: BONE MARROW EDEMA; MAGNETIC RESONANCE; RAMRIS; REMISSION; RHEUMATOID ARTHRITIS