The role of MRI in rheumatoid arthritis: research and clinical issues

Freeston, Jane; Bird, Paul; Conaghan, Philip G.

doi:10.1097/bor.0b013e32832498f0

Cited by 34 publications

(30 citation statements)

References 40 publications

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“…MRI visualises bone damage (erosions) with increased sensitivity over conventional radiography and enables detection of synovial inflammation (synovitis) and bone oedema (osteitis) 1 2 5. While early MRI studies used longitudinal observational cohorts to assess disease progression and therapeutic response,5 relatively few randomised controlled trials (RCTs) have included this technique as a key outcome 3 4 6–11…”

Section: Introductionmentioning

confidence: 99%

Impact of intravenous abatacept on synovitis, osteitis and structural damage in patients with rheumatoid arthritis and an inadequate response to methotrexate: the ASSET randomised controlled trial

et al. 2012

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ObjectivesThis randomised, double-blind, placebo-controlled phase IIIb study evaluated the impact of abatacept on MRI pathology as a primary outcome in methotrexate (MTX)-refractory patients with rheumatoid arthritis.MethodsPatients received intravenous abatacept (∼10 mg/kg) or placebo, on background MTX, for 4 months, followed by an 8-month open-label extension (OLE; all patients received abatacept plus MTX). Patients had 1.5T MRI with intravenous contrast at baseline, Months 4 and 12; wrist synovitis (three locations assessed), and wrist and hand (15 and eight locations assessed, respectively) osteitis and erosion were scored using OMERACT-RAMRIS.Results26/27 abatacept- and 23/23 placebo-randomised patients completed Month 4 and entered the OLE; 26 and 21 completed Month 12. The primary endpoint was not achieved; mean change (SD) from baseline in synovitis was −0.44 (1.47) for abatacept versus 0.52 (1.38) for placebo (p=0.103) at Month 4. For mean change in synovitis adjusted for baseline score (sensitivity analysis), the difference between groups was −0.69, p=0.078. Adjusted mean changes (SE) in osteitis and erosion were −1.94 (0.86) and 0.45 (0.43) for abatacept, and 1.54 (0.90) and 0.95 (0.45) for placebo. Further MRI improvements were observed up to Month 12 for abatacept and from Months 4 to 12 for placebo-treated patients switched to abatacept at Month 4. Clinical efficacy was shown with abatacept and sustained to Month 12.ConclusionsDespite small patient numbers, MRI detected structural and synovial benefit, sustained to Month 12 in abatacept+MTX-treated patients, and improvements in structural and inflammatory outcomes for placebo+MTX-treated patients following addition of abatacept.Clinical trial registrationClinicaltrials.gov NCT00420199.

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Section: Introductionmentioning

confidence: 99%

Impact of intravenous abatacept on synovitis, osteitis and structural damage in patients with rheumatoid arthritis and an inadequate response to methotrexate: the ASSET randomised controlled trial

et al. 2012

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“…reduced number of possible imaging techniques compared to whole-body units, especially the lack of selective fat saturation sequences (FS/SPAIR) [6, 7]. …”

Section: Magnetic Resonance Imaging Hardware and Magnetsmentioning

confidence: 99%

Magnetic resonance imaging in inflammatory rheumatoid diseases

et al. 2016

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Magnetic resonance (MR) is used more and more frequently to diagnose changes in the musculoskeletal system in the course of rheumatic diseases, at their initial assessment, for treatment monitoring and for identification of complications. The article presents the history of magnetic resonance imaging, the basic principles underlying its operation as well as types of magnets, coils and MRI protocols used in the diagnostic process of rheumatic diseases. It enumerates advantages and disadvantages of individual MRI scanners. The principles of MRI coil operation are explained, and the sequences used for MR image analysis are described, particularly in terms of their application in rheumatology, including T1-, T2-, PD-weighted, STIR/TIRM and contrast-enhanced T1-weighted images. Furthermore, views on the need to use contrast agents to optimise diagnosis, particularly in synovitis-like changes, are presented. Finally, methods for the assessment of MR images are listed, including the semi-quantitative method by RAMRIS and quantitative dynamic examination.

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“…Both modalities are characterized by high sensitivity in depicting local inflammation in the form of synovitis, tenosynovitis and bursitis, which is greater than in clinical examination and conventional radiography and can help establish an early diagnosis in RA (3) .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the multiplane, multislice capability of MRI allows visualization of the area of interest in three orthogonal planes. Therefore, MRI has the advantage of providing details concerning both the bone and surrounding tissues of the joint, which is not shared by any other imaging modality, whilst avoiding ionizing radiation (3) .…”

Section: Introductionmentioning

confidence: 99%

Reumatoidalne zapalenie stawów w badaniu MR i ultrasonografii

2017

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Rheumatoid arthritis is the most common inflammatory arthritis, affecting approximately 1% of the world’s population. Its pathogenesis has not been completely understood. However, there is evidence that the disease may involve synovial joints, subchondral bone marrow as well as intra- and extraarticular fat tissue, and may lead to progressive joint destruction and disability. Over the last two decades, significant improvement in its prognosis has been achieved owing to new strategies for disease management, the emergence of new biologic therapies and better utilization of conventional disease-modifying antirheumatic drugs. Prompt diagnosis and appropriate therapy have been recognized as essential for improving clinical outcomes in patients with early rheumatoid arthritis. Despite the potential of ultrasonography and magnetic resonance imaging to visualize all tissues typically involved in the pathogenesis of rheumatoid arthritis, the diagnosis of early disease remains difficult due to limited specificity of findings. This paper summarizes the pathogenesis phenomena of rheumatoid arthritis and describes rheumatoid arthritis-related features of the disease within the synovium, subchondral bone marrow and articular fat tissue on MRI and ultrasound. Moreover, the paper aims to illustrate the significance of MRI and ultrasound findings in rheumatoid arthritis in the diagnosis of subclinical and early inflammation, and the importance of MRI and US in the follow-up and establishing remission. Finally, we also discuss MRI of the spine in rheumatoid arthritis, which may help assess the presence of active inflammation and complications.

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The role of MRI in rheumatoid arthritis: research and clinical issues

Abstract: This review has highlighted both recent research advances as well as the future potential for MRI in RA, with the aim that MRI will become part of standard measures for RA clinical trials. With respect to extremity imaging, further work is required to provide useful clinical algorithms.

Cited by 34 publications

References 40 publications

Impact of intravenous abatacept on synovitis, osteitis and structural damage in patients with rheumatoid arthritis and an inadequate response to methotrexate: the ASSET randomised controlled trial

Impact of intravenous abatacept on synovitis, osteitis and structural damage in patients with rheumatoid arthritis and an inadequate response to methotrexate: the ASSET randomised controlled trial

Magnetic resonance imaging in inflammatory rheumatoid diseases

Reumatoidalne zapalenie stawów w badaniu MR i ultrasonografii

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