Silent progression in patients with rheumatoid arthritis: is DAS28 remission an insufficient goal in RA? Results from the German Remission-plus cohort

Abstract

BackgroundRemission is arguably the ultimate therapeutic goal in rheumatoid arthritis (RA). Applying modern strategies, clinical remission can be achieved in a substantial number of patients with early RA (ERA). Even in those patients, the number and scope of erosions can increase. We, therefore, investigated the value of MRI for the detection of radiological progression in patients with DAS28 improvement and/or clinical remission of the German Remission-plus cohort.MethodsData-sets of 80 RA patients (according to 2010 ACR/EULAR criteria) from the Remission-plus study cohort, who fulfilled the following criteria, were retrospectively analysed: availability of two consecutive MRI scans (low-field MRI, follow-up interval 1 year) of the clinically dominant hand and wrist, and the presence of DAS28 (CRP) scores at both time points, which was used to assess disease activity.ResultsSeventy-one of the 80 investigated patients presented a numerical improvement of the DAS28 (CRP) after 12 months (DAS28(CRP) T0 average (Ø) 4.96, SD 1.2; DAS28 T4 (12 month) Ø 2.6, SD 1.0), 73% of them also improved in the RAMRIS-Score, while 24% demonstrated an increase despite DAS28 improvement and 3% showed equal values. 48% of patients who improved in the DAS28 reached EULAR remission. 41% of these patients had an increase in the RAMRIS Erosion-subscore after 12 months. When considering EULAR response criteria (non-response (n = 7), moderate response (n = 19), good response (n = 45)), an increase of erosions was found in 71.4% of non-responders, 52.6% of moderate responders, and 31.1% of good responders after 12 months, all compared to baseline.ConclusionUp to 40% of patients in this study demonstrated a progressive erosive disease detected by MRI despite DAS28 improvement or EULAR remission. Future studies are needed to determine the prognostic clinical impact of disease progression in MRI despite clinical remission, and to investigate if DAS28 remission may be an insufficient therapeutic goal and should be accompanied by MRI remission criteria.

Differential regulation and correlation between galectin-9 and anti-CCP antibody (ACPA) in rheumatoid arthritis patients

“…Gal-9 has been suggested to play a role in RA pathogenesis, but the underlying mechanisms have not been elucidated. Previous studies suggest that the measurement of disease activity alone is not sufficient to identify fast progressing RA and high titers of ACPA could be a risk factor for RA progression [21,22]. The correlation between Gal-9 and ACPA observed in our study may suggest that high titers of ACPA may be linked to the rheumatoid inflammatory process through the Gal-9-mediated bone effects indirectly.…”

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

“…Eighteen percent of individual patients did, however, show significant (≥SDC) progression of erosion score. With only two time-points for imaging (screening/baseline and Week 24), it cannot be known whether these structural changes represented progression of disease despite treatment—progression has been reported in other studies, despite clinical remission [14, 15]—or if the structural changes observed at Week 24 actually developed only during the initial period of treatment prior to TCZ reaching its maximum inhibitory effect. Additional time-points would be needed to determine this and whether residual inflammation visible at Week 24 was sufficient to keep joint damage progressing (Figure 1).…”

Magnetresonanztomografie peripherer Gelenke

“…Dabei befindet sich der Patient außerhalb des Hauptmagnetfeldes und lediglich die Hand wird innerhalb des Magneten gelagert. Der im Vergleich zum HF-MRT niedrigeren Ortsauflösung zum Trotz, können mittels NF-MRT vergleichbare Aussagen zu Erosionen, Synovialitis und Therapieansprechen getroffen werden [17][18][19][20]. Bei einem zudem deutlich niedrigeren Anschaffungspreis sind NF-Scanner in Wissenschaft und Praxis von zunehmendem Interesse.…”