title: MRI-detected subclinical joint inflammation is associated with radiographic progression.
abstract: BACKGROUND
  We recently demonstrated that MRI inflammation is prevalent in clinically non-swollen joints of early arthritis patients. In this study, we assessed the relevance of this subclinical inflammation with regard to radiographic progression.
  
  
  METHODS
  1130 joints (unilateral metacarpophalangeal 2-5, wrist and metatarsophalangeal 1-5) of 113 early arthritis patients underwent clinical examination and 1.5 T MRI at baseline, and radiographs at baseline and 1 year. Two readers scored the MRIs for synovitis, bone marrow oedema (BME) and tenosynovitis according to Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) Scoring System (RAMRIS). Radiographic progression over 1 year was determined using the Sharp-van der Heijde scoring method.
  
  
  RESULTS
  On patient level, BME, synovitis and tenosynovitis were associated with radiographic progression, independent of known risk factors (p=0.003, 0.001 and 0.011, respectively). Of all non-swollen joints (n=932), 232 joints (26%) had subclinical inflammation (≥1 MRI-inflammation feature present). These joints were distributed among 91% of patients. Radiographic progression was present in 4% of non-swollen joints with subclinical inflammation compared to 1% of non-swollen joints without subclinical inflammation (relative risks (RR) 3.5, 95% CI 1.3 to 9.6). Similar observations were done for BME (RR5.3, 95% CI 2.0 to 14.0), synovitis (RR3.4, 95% CI 1.2 to 9.3) and tenosynovitis (RR3.0, 95% CI 0.7 to 12.7) separately.
  
  
  CONCLUSIONS
  Radiographic progression was infrequent, but joints with subclinical inflammation had an increased risk of radiographic progression within year 1. This demonstrates the relevance of MRI-detected subclinical inflammation.
authors: Department of Rheumatology, Leiden University Medical Center, The Netherlands.
authors: A
authors: A
authors: Krabben
authors: Department of Radiology, Leiden University Medical Center, The Netherlands.
authors: W
authors: W
authors: Stomp
authors: Department of Rheumatology, Leiden University Medical Center, The Netherlands.
authors: J A B
authors: JA
authors: van Nies
authors: Department of Rheumatology, Leiden University Medical Center, The Netherlands.
authors: T W J
authors: TW
authors: Huizinga
authors: Department of Rheumatology, Leiden University Medical Center, The Netherlands.
authors: D
authors: D
authors: van der Heijde
authors: Department of Radiology, Leiden University Medical Center, The Netherlands.
authors: J L
authors: JL
authors: Bloem
authors: Department of Radiology, Leiden University Medical Center, The Netherlands.
authors: M
authors: M
authors: Reijnierse
authors: Department of Rheumatology, Leiden University Medical Center, The Netherlands.
authors: A H M
authors: AH
authors: van der Helm-van Mil
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001855:Bone Marrow Diseases / Q000175:diagnosis / Q000209:etiology; D018450:Disease Progression; D042241:Early Diagnosis; D004487:Edema / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012720:Severity of Illness Index; D013585:Synovitis / Q000175:diagnosis / Q000209:etiology; D013717:Tenosynovitis / Q000175:diagnosis / Q000209:etiology; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000473:pathology
keywords: Arthritis; Inflammation; Magnetic Resonance Imaging; Outcomes research; Rheumatoid Arthritis