RESEARCH - MRI bone edema is the strongest predictor of subsequent radiographic progression in early RA: CIMESTRA

[Guest guest]

ls of the Rheumatic Diseases 2009;68:384-390

MRI bone oedema is the strongest predictor of subsequent radiographic

progression in early rheumatoid arthritis. Results from a 2-year

randomised controlled trial (CIMESTRA)

M L Hetland1, B Ejbjerg1,2, K Hørslev-sen3, S sen4, A

Vestergaard5, A G Jurik6, K Stengaard-Pedersen7, P Junker8, T

Lottenburger3, I Hansen7, L S Andersen3, U Tarp7, H Skjødt1, J K

Pedersen3, O Majgaard1, A J Svendsen3, T Ellingsen7, H Lindegaard8, A

F Christensen8, J Vallø9, T Torfing10, E Narvestad5, H S Thomsen11, M

Østergaard3 and and the CIMESTRA study group

1 Department of Rheumatology, Copenhagen University Hospital, Hvidovre, Denmark

2 Department of Rheumatology, Copenhagen University Hospital, Herlev, Denmark

3 Department of Rheumatology, Rheumatism Hospital, University of

Southern Denmark, Gråsten, Denmark

4 Department of Rheumatology, Rigshospitalet, University of

Copenhagen, Copenhagen, Denmark

5 Department of Radiology, Copenhagen University Hospital, Hvidovre, Denmark

6 Department of Radiology, Århus University Hospital, Århus, Denmark

7 Department of Rheumatology, Århus University Hospital, Århus, Denmark

8 Department of Rheumatology, Odense University Hospital, Odense, Denmark

9 Department of Radiology, Aabenraa Sygehus, Aabenraa, Denmark

10 Department of Radiology, Odense University Hospital, Odense, Denmark

11 Department of Radiology, Copenhagen University Hospital, Herlev, Denmark

Objective: To identify predictors of radiographic progression in a

2-year randomised, double-blind, clinical study (CIMESTRA) of patients

with early rheumatoid arthritis (RA).

Methods: Patients with early RA (n = 130) were treated with

methotrexate, intra-articular betamethasone and

ciclosporin/placebo-ciclosporin. Baseline magnetic resonance imaging

(MRI) of the wrist (wrist-only group, n = 130) or MRI of wrist and

metacarpophalangeal (MCP) joints (wrist+MCP group, n = 89) (OMERACT

RAMRIS), x-ray examination of hands, wrists and forefeet (Sharp/van

der Heijde Score (TSS)), Disease Activity Score (DAS28), anti-cyclic

citrullinated peptide antibodies (anti-CCP), HLA-DRB1-shared epitope

(SE) and smoking status were assessed. Multiple regression analysis

was performed with delta-TSS (0–2 years) as dependent variable and

baseline DAS28, TSS, MRI bone oedema score, MRI synovitis score, MRI

erosion score, anti-CCP, smoking, SE, age and gender as explanatory

variables.

Results: Baseline values: median DAS28 5.6 (range 2.4–8.0); anti-CCP

positive 61%; radiographic erosions 56%. At 2 years: DAS28 2.0

(0.5–5.7), in DAS remission: 56%, radiographic progression 26%

(wrist+MCP group, similar for wrist-only group). MRI bone oedema score

was the only independent predictor of delta-TSS (wrist+MCP group:

coefficient = 0.75 (95% CI 0.55 to 0.94), p<0.001; wrist-only group:

coefficient = 0.59 (95% CI 0.40 to 0.77), p<0.001). Bone oedema score

explained 41% of the variation in the progression of TSS (wrist+MCP

group), 25% in wrist-only group (Pearson’s r = 0.64 and r = 0.50,

respectively). Results were confirmed by sensitivity analyses.

Conclusion: In a randomised controlled trial aiming at remission in

patients with early RA, baseline RAMRIS MRI bone oedema score of MCP

and wrist joints (and of wrist only) was the strongest independent

predictor of radiographic progression in hands, wrists and forefeet

after 2 years. MRI synovitis score, MRI erosion score, DAS28,

anti-CCP, SE, smoking, age and gender were not independent risk

factors.

http://ard.bmj.com/cgi/content/abstract/68/3/384

Not an MD