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Author(s):
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John R. Tesser1, Lisa Ballehr2,
Randy Jay1, Barbara Keske1, Maurisa Konya1,
Scott Brown1, Paul Caldron1, John Starr1,
Eric Peters1, Ralph Bennett1, Areena Swarup1,
Ramina Jajoo1, Jill Bolignese1, Sheetal Chhaya1,
Mike D'Onofrio3. 1AZ Arthritis & Rheumatology Ass, Paradise Valley, AZ; 2NAOI,
Mesa, AZ; 3ASU,
Tempe, AZ
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Purpose: We report the first clinical
experience utilizing MRI standardized RAMRIS scoring in assessing rheumatoid
arthritis (RA) in clinical practice. In RA, radiography (XR) is considered
the gold standard measure of structural integrity both in clinical practice and
in research studies. Ultrasound and MRI are more sensitive for erosions (E)
and synovitis (S), and MRI is able to detect osteitis(O)/marrow edema.
Methods: We reviewed the first 800 patients who received MRIs. Imaging was
performed using a 1.0T ONI extremity scanner. Cor T1, 2D GE, STIR and Axial
T1, STIR sequences were obtained of two extremities in most every subject.
Regional combinations of right or left 2nd through 5th
MCP joints, 1st through 5th MTP joints and/or wrist
(WR) MRI studies were read by a musculoskeletal fellowship trained
radiologist. An OMERACT/RAMRIS scoring method evaluating severity and extent
of (S), (O) and (E) were recorded for each bone and joint. Bones were scored
0-10 for percent volume involvement and scored 0-3 for % volume edema. Each
joint was scored 0-3 based on % joint distention. Total scores (T) were the
sum E, O and S scores for each region. (Ostergaard, J Rheumatol
2003;30:1385-6.)
Results: T and component mean RAMRIS scores for the entire population with
available data are: T = 23.6, E = 12.6, O = 5.2, S = 5.8, O+S = 11.0. Mean
disease duration was 8.3 . For time periods of disease duration the mean
RAMRIS scores are:
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MRI
RAMRIS YRS
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N
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Mean
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95%
Confidence Interval for Mean
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Lower
Bound
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Upper
Bound
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TOTAL
SCORES
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0-2
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167
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13.6
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11.1
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16.1
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2-5
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93
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18.3
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14.4
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22.2
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>5
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249
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32.3
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28.7
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36.0
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Total
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509
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23.6
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21.4
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25.8
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TOTAL
E
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0-2
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167
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5.5
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4.1
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6.9
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2-5
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93
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9.3
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6.7
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11.8
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>5
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249
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18.6
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16.0
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21.3
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Total
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509
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12.6
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11.1
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14.1
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TOTAL
O
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0-2
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167
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3.6
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2.7
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4.5
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2-5
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93
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4.1
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3.0
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5.1
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>5
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249
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6.5
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5.6
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7.4
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Total
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509
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5.1
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4.5
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5.7
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TOTAL
S
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0-2
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167
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4.4
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3.8
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5.0
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2-5
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93
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4.9
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4.1
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5.7
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>5
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249
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7.1
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6.6
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7.7
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Total
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509
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5.8
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5.4
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6.2
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TOTAL
OS
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0-2
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167
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8.1
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6.8
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9.4
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2-5
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93
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9.0
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7.4
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10.6
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>5
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249
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13.7
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12.3
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15.0
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Total
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509
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11.0
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10.1
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11.8
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All values were p < .001.
Mean scores for joint regions were: WR (T=8.1, E=12.9, O=3.9, S=3.9,
O+S=3.9), MCPs (T=8.3, E=5.3, O=2.5, S=3.6, O+S=3.1), MTPs (T=7.2, E=12.9,
O=3.9, S=3.9, O+S=3.9). Correlations: WR-MCPs=-1.4, WR-MTPs=.10,
MCPs-MTPs=1.4. 202 total patients had XRs and MRIs. 112 had +XRs (55.4% of
total) and 135 patients had +MRIs (67.8%) for E. There were MRI-/XR+ patients
(53.5% total), XR-/MRI+ patients (27/108, 25%), MRI-/XR+ patients (4/108,
3.6% total), XR-/MRI- patients (31.1% total).
Conclusions: The mean MRI RAMRIS T score was 23.6 units over 8.3 yrs, a rate
of X RAMRIS 2.8 units/year. We sawa very significant correlation between T
and component scores and yrs of disease. WR proved to have higher sensitivity
for damage scores than MCPs or MTPs. WR were more sensitive than MCPs which
were more sensitive than MTPs. MRIs were more sensitive for erosive damage
than Xrays. MRI RAMRIS scores were more practical and useful to assess
severity of damage than XRs.
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Disclosures:
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J.R. Tesser, Genentech-BI, Wyeth/Amgen, Merck,
Lilly, GSK, 8 Speakers bureau.
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