title: Comprehensive appraisal of magnetic resonance imaging findings in sustained rheumatoid arthritis remission: a substudy.
abstract: OBJECTIVE
  To evaluate the effect of sustained American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission on residual joint inflammation assessed by magnetic resonance imaging (MRI) and to secondarily evaluate other clinical definitions of remission, within an early seropositive rheumatoid arthritis (RA) cohort.
  
  
  METHODS
  A subcohort of 118 RA patients was enrolled from patients who completed the 2-year, double-blind randomized Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) trial. Patients received a single contrast-enhanced 1.5T MRI of their most involved wrist. Two readers scored MRIs for synovitis, osteitis, tenosynovitis, and erosions. Clinical assessments were performed every 3 months during the trial and at time of MRI.
  
  
  RESULTS
  The subcohort was 92% seropositive with mean age 51 years, duration 4.1 months, and Disease Activity Score in 28 joints using the erythrocyte sedimentation rate 5.8 at TEAR entry. Total MRI inflammatory scores (tenosynovitis + synovitis + osteitis) were lower among patients in clinical remission. Lower MRI scores were correlated with longer duration of Clinical Disease Activity Index (CDAI) remission (ρ = 0.22, P = 0.03). At the time of MRI, 89 patients had no wrist pain/tenderness/swelling; however, all 118 patients had MRI evidence of residual joint inflammation after 2 years. No statistically significant differences in damage or MRI inflammatory scores were observed across treatment groups.
  
  
  CONCLUSIONS
  This is the first detailed appraisal describing the relationship between clinical remission cut points and MRI inflammatory scores within an RA randomized controlled trial. The most stringent remission criteria (2011 ACR/EULAR and CDAI) best differentiate the total MRI inflammatory scores. These results document that 2 years of triple therapy or tumor necrosis factor plus methotrexate treatment in early RA does not eliminate MRI evidence of joint inflammation.
authors.affiliation: University of California, Los Angeles.
authors.forename: Veena K
authors.initials: VK
authors.lastname: Ranganath
authors.affiliation: University of California, Los Angeles.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Motamedi
authors.affiliation: Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Espen A
authors.initials: EA
authors.lastname: Haavardsholm
authors.affiliation: University of California, Los Angeles.
authors.forename: Paul
authors.initials: P
authors.lastname: Maranian
authors.affiliation: University of California, Los Angeles.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Fiona
authors.initials: F
authors.lastname: McQueen
authors.affiliation: University of California, Los Angeles.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Duffy
authors.affiliation: Columbia University, New York, New York.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Bathon
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: University of California, Los Angeles.
authors.forename: Weiling
authors.initials: W
authors.lastname: Chen
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Larry
authors.initials: L
authors.lastname: Moreland
authors.affiliation: University of California, Los Angeles.
authors.forename: James
authors.initials: J
authors.lastname: Louie
authors.affiliation: Touro University Nevada, Las Vegas.
authors.forename: Sogol
authors.initials: S
authors.lastname: Amjadi
authors.affiliation: University of Nebraska Medical Center, Omaha.
authors.forename: James
authors.initials: J
authors.lastname: O'Dell
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Stacey S
authors.initials: SS
authors.lastname: Cofield
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: E William
authors.initials: EW
authors.lastname: St Clair
authors.affiliation: University of Alabama at Birmingham.
authors.forename: S Louis
authors.initials: SL
authors.lastname: Bridges
authors.affiliation: University of California, Los Angeles.
authors.forename: Harold E
authors.initials: HE
authors.lastname: Paulus
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D012074:Remission Induction / Q000379:methods
chemical_list: D018501:Antirheumatic Agents