Short-term changes on MRI predict long-term changes on radiography in rheumatoid arthritis: an analysis by an OMERACT Task Force of pooled data from four randomised controlled trials

Abstract

Objective: In rheumatoid arthritis (RA), magnetic resonance imaging (MRI) provides earlier detection of structural damage than radiography (X-ray) and more sensitive detection of intra-articular inflammation than clinical examination. This analysis was designed to evaluate the ability of early MRI findings to predict subsequent structural damage by X-ray. Methods: Pooled data from 4 randomized controlled trials (RCTs) involving 1022 RA hands and wrists in early and established RA were analyzed. X-rays were scored using van der Heijde-or Genant-modified Sharp methods. MRIs were scored using Outcome Measures in Rheumatology (OMERACT) RA MRI Score (RAMRIS). Data were analyzed at the patient level using multivariable logistic regression and Receiver Operating Characteristic (ROC) curve analyses. Results: Progression of MRI erosion scores at Weeks 12 and 24 predicted progression of X-ray erosions at Weeks 24 and 52, with areas under the curve (AUCs) of 0.64 and 0.74, respectively. Twelve-and 24-week changes in MRI osteitis scores were similarly predictive of 24-and 52-week X-ray erosion progression; pooled AUCs 0.78 and 0.77, respectively. MRI changes in synovitis at Weeks 12 and 24 also predicted progression of X-ray joint damage (erosion and joint-space narrowing) at Weeks 24 and 52 (AUCs = 0.72 and 0.65, respectively). Conclusion: Early changes in joint damage and inflammation detected with MRI predict changes in joint damage evident on subsequent X-rays. These findings support the use of MRI as a valid method for monitoring structural damage in short-duration RCTs.

AC-CUTE: An Open-Label Study to Evaluate Progression of Structural Joint Damage and Inflammation in Subjects with Moderate to Severe Rheumatoid Arthritis

“…Another limitation of this study was the small subject numbers in each subgroup, especially SC-TCZM ( n = 17). Although MRI has been reported to discriminate treatment effects on progression of bone erosion and cartilage loss in placebo-controlled trials with as few as 30 patients per arm and follow-up intervals of only 12 weeks [16–18], more patients and longer intervals than even 24 weeks may be necessary to do so in active-comparator trials, such as this one. Much larger numbers of patients are typically required to demonstrate efficacy in 24 weeks with radiography in placebo-controlled trials, let alone active-comparator trials.…”

Assessment of Cortical Interruptions in the Finger Joints of Patients With Rheumatoid Arthritis Using HR-pQCT, Radiography, and MRI

“…With CT as a reference method, sensitivity to detect erosions in metacarpophalangeal (MCP) joints was 26% and 68% for CR and MRI, respectively . In addition, MRI is able to visualize inflammation in the joint, such as bone marrow edema (BME) and synovitis, which are associated with the progression of bone damage on CR in patients with RA …”

“…inflammation in the joint, such as bone marrow edema (BME) and synovitis, which are associated with the progression of bone damage on CR in patients with RA. (8)(9)(10) Another imaging modality used in RA is high-resolution peripheral quantitative CT (HR-pQCT), which can visualize the 3D bone structure of the peripheral skeleton at the microscale level (82-mm isotropic voxel size) in vivo. Comparative studies have shown that HR-pQCT imaging is more sensitive than MRI and CR in the detection of pathological interruptions (ie, erosions) in finger joints.…”

Imaging in rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and osteoarthritis: An international viewpoint on the current knowledge and future research priorities

“…Table 3 presents the proposal for a research agenda for future RA clinical trials. For MRI, early erosion progression has been documented as a valid measure of structural damage that could decrease sample size and study duration if it was used as an endpoint in RA clinical trials (6, 43–45), but further corroborative research is needed if MRI is to gain regulatory agencies’ acceptance.…”