title: MRI evidence of persistent joint inflammation and progressive joint damage despite clinical remission during treatment of early rheumatoid arthritis.
abstract: OBJECTIVE
  To determine the value of magnetic resonance imaging (MRI) of bones and joints in patients with recent-onset rheumatoid arthritis (RA) treated for 2 years from diagnosis with disease-modifying anti-rheumatic drugs (DMARDs) and glucocorticoids.
  
  
  METHODS
  Thirteen patients with early RA were treated according to clinical practice and followed with MRI, radiographs, and Disease Activity Score calculated on 28 joints (DAS28) at inclusion (baseline) and after 1, 4, 7, 13, and 25 months. MRI of the dominant wrist and metacarpophalangeal (MCP) joints were assessed for synovitis, bone oedema, and erosions using the RA MRI Score (RAMRIS) and for tenosynovitis by an MRI tenosynovitis scoring method. Radiographs were assessed by the van der Heijde modified Sharp score (SHS). Clinical remission was defined by a DAS28 < 2.6.
  
  
  RESULTS
  MRI at baseline detected inflammation in joints and tendons in all patients as well as erosions in 10 out of 13 patients. Over time, the erosion score increased while the synovitis and tenosynovitis scores remained almost unchanged. Bone oedema strongly correlated with synovitis. Synovitis and tenosynovitis correlated well with the erosion score at baseline but not thereafter. The MRI changes showed that joint damage started early and continued in the presence of persistent synovial and tenosynovial inflammation.
  
  
  CONCLUSIONS
  The observations made in this small study suggest that the treatment goal of 'clinical remission' should be supplemented by a 'joint remission' goal. To this end, MRI is an appropriate tool. Further studies are needed to evaluate the optimal use of MRI in early RA.
authors: a Department of Clinical Sciences, Section of Rheumatology , Lund University , Helsingborg , Sweden.|b Department of Medicine, Section of Rheumatology , Helsingborgs Lasarett , Helsingborg , Sweden.
authors: K
authors: K
authors: Forslind
authors: c Department of Clinical Sciences, Section of Rheumatology , Lund University , Lund , Sweden.
authors: B
authors: B
authors: Svensson
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000473:pathology*; D018450:Disease Progression; D004487:Edema / Q000473:pathology*; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D050276:Hand Bones / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint / Q000473:pathology*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011379:Prognosis; D012074:Remission Induction; D012720:Severity of Illness Index; D013585:Synovitis / Q000473:pathology*; D013717:Tenosynovitis / Q000473:pathology*; D014955:Wrist Joint
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; C529000:golimumab; D011239:Prednisolone; D000068800:Etanercept; D008727:Methotrexate