Value of MRI and ultrasound for prediction of therapeutic response and erosive progression in patients with early rheumatoid arthritis managed by an aggressive treat-to-target strategy

Abstract

ObjectivesTo investigate if inflammation detected by MRI or ultrasound at rheumatoid arthritis (RA) onset is predictive of erosive progression or poor response to methotrexate monotherapy, and to investigate if subclinical inflammation in remission is predictive of future treatment escalation or erosive progression.MethodsIn a 2-year study, 218 patients with disease-modifying antirheumatic drug-naïve early RA were treated by a tight-control treat-to-target strategy corresponding to current recommendations. MRI and ultrasound were performed at regular intervals. Baseline imaging-based inflammation measures were analysed as predictors for early methotrexate failure and erosive progression using univariate and multivariate regression adjusted for clinical, laboratory and radiographic measures. In patients in remission after 1 year, imaging measures were analysed as predictors of treatment escalation and erosive progression during the second year. The added value of imaging in prediction models was assessed using receiver operating characteristic analyses.ResultsBaseline MRI inflammation was associated with MRI erosive progression and ultrasound with radiographic erosive progression. No imaging inflammation measure was associated with early methotrexate failure. Imaging inflammation was present in a majority of patients in clinical remission. Tenosynovitis was associated with treatment escalation, and synovitis and tenosynovitis with MRI/radiographic erosive progression during the second year. Imaging information did not improve prediction models for any of the outcomes.ConclusionsImaging-detected inflammation, both at diagnosis and in remission, is associated with elements of future disease development. However, the lack of a significant effect on prediction models indicates limited value of systematic MRI and ultrasound in management of early RA.

The Programmed Death-1 Pathway Counter-Regulates Inflammation-Induced Osteoclast Activity in Clinical and Experimental Settings

“…Continuous antigen presentation sustains inflammation, which supports the association between sPD-1 and autoantibody seropositivity in eRA. Some patients have persistently high sPD-1 levels, probably reflecting persistent subclinical disease activity as observed in imaging studies, which may explain why radiographic progression is particularly prominent in this subset of patients ( 48 ).…”

Importance of baseline musculoskeletal ultrasound findings in the prognosis of rheumatoid arthritis

“…Möller et al [34] also confirmed that GSUS appears to be an essential component of synovitis assessment, higher levels of GSUS are associated with the development of erosion. Sundin et al [35] reported that the systematic use of MRI or US detected inflammation, both at diagnosis and in remission is associated with the elements of future disease development. However, Andrea et al [36] reported that in anti-CCP + at-risk individuals with musculoskeletal symptoms, CRdetected erosion is uncommon and does not predict the development of inf lammatory arthritis (IA).…”

Rheumatoid Arthritis Relapse and Remission – Advancing Our Predictive Capability Using Modern Imaging

“…A high number of studies has been able to demonstrate that subclinical inflammation seen by ultrasound and MRI is present in a substantial proportion of RA patients in clinical remission, in both joints and tendons 12–21 , 24 , 25 , 28 ( Figures 1 and 2 ). Subclinical synovitis is present independent of using DAS28, CDAI, SDAI or even the more stringent ACR/EULAR Boolean remission criteria for determining clinical remission, and its presence is found to be independent of the type of treatment given, ie csDMARD or bDMARD.…”

“…The randomized controlled ARCTIC trial 49 investigated whether adding ultrasound information to the treatment decisions in early RA was better than clinical strategy alone, and found that the majority of patients in remission in both groups had subclinical synovitis by ultrasound and MRI after 1 year. 28 However, a randomized controlled trial in patients in clinical remission on csDMARDs investigated an MRI T2T strategy, aiming at eliminating osteitis, compared with a clinical T2T strategy. 50 The study found statistically significantly higher improvements in osteitis, tenosynovitis and total inflammation, and a trend towards higher improvement in synovitis, in the MRI T2T arm compared to the clinical T2T arm, 50 although subclinical inflammation was not totally eliminated.…”

“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] This is also the reason for acknowledging the use of ultrasound and MRI for joint assessment in the 2010 ACR/EULAR classification criteria for RA, facilitating an earlier fulfilment of the classification criteria. 27 A high number of studies has been able to demonstrate that subclinical inflammation seen by ultrasound and MRI is present in a substantial proportion of RA patients in clinical remission, in both joints and tendons [12][13][14][15][16][17][18][19][20][21]24,25,28 (Figures 1 and 2). Subclinical synovitis is present independent of using DAS28, CDAI, SDAI or even the more stringent ACR/EULAR Boolean remission criteria for determining clinical remission, and its presence is found to be independent of the type of treatment given, ie csDMARD or bDMARD.…”