RESEARCH - A prediction rule for disease outcome in patients with undifferentiated arthritis using MRI of the wrists and finger joints and serologic autoantibodies

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Arthritis Rheum. 2009 May 28;61(6):772-778.

A prediction rule for disease outcome in patients with

undifferentiated arthritis using magnetic resonance imaging of the

wrists and finger joints and serologic autoantibodies.

Tamai M, Kawakami A, Uetani M, Takao S, Arima K, Iwamoto N, Fujikawa

K, Aramaki T, Kawashiri SY, Ichinose K, Kamachi M, Nakamura H,

Origuchi T, Ida H, Aoyagi K, Eguchi K.

Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.

OBJECTIVE: To evaluate whether magnetic resonance imaging (MRI) of the

wrists and finger joints and an analysis of serologic autoantibodies

are clinically meaningful for the subsequent development of rheumatoid

arthritis (RA) in patients with undifferentiated arthritis (UA).

METHODS: A total of 129 patients with UA, a disease status formally

confirmed by a rheumatologist over a period of at least 1 year, were

included. Gadolinium-diethylenetriamine-enhanced MRI of both wrists

and finger joints and serologic variables were examined upon admission

to our Early Arthritis Clinic at Nagasaki University. After a

prospective followup of 1 year, a predictive value for the development

of RA was determined for each patient.

RESULTS: The subjects were evaluated for their positive or negative

status with respect to 3 objective measures at study entry:

anti-cyclic citrullinated peptide (anti-CCP) antibodies and/or

IgM-rheumatoid factor, MRI-proven symmetric synovitis, and MRI-proven

bone edema and/or bone erosion. The patients who were positive for at

least 2 of these measures progressed to RA at 1 year with a 79.7%

positive predictive value (PPV), 63.0% negative predictive value,

75.9% specificity, 68.0% sensitivity, and 71.3% accuracy. Furthermore,

in 22 UA patients positive for both anti-CCP antibodies and MRI-proven

bone edema who were considered to have progressed to RA at 1 year, the

PPV was increased to 100%. A close correlation was found between the

present rule and that established in the Leiden Early Arthritis

Cohort.

CONCLUSION: MRI-proven early joint damage in conjunction with

serologic autoantibodies is efficient in predicting progression from

UA to RA. This method can be used to identify patients who would

benefit from early treatment with disease-modifying antirheumatic

drugs.

PMID: 19479686

http://www.ncbi.nlm.nih.gov/pubmed/19479686

Not an MD