MRI BONE OEDEMA IS A STRONG PREDICTOR OF THE SUBSEQUENT 5-YEAR RADIOGRAPHIC PROGRESSION IN EARLY RHEUMATOID ARTHRITIS. RESULTS FROM A RANDOMIZED CONTROLLED TRIAL (CIMESTRA)

6. [SAT0006] MRI BONE OEDEMA IS A STRONG PREDICTOR OF THE SUBSEQUENT 5-YEAR RADIOGRAPHIC PROGRESSION IN EARLY RHEUMATOID ARTHRITIS. RESULTS FROM A RANDOMIZED CONTROLLED TRIAL (CIMESTRA)

M. L. Hetland*¹, B. Ejberg², M. Østergaard², S. Jacobsen², A. Vestergaard², A. Jurik², K. Stengaard-Pedersen², P. Junker², T. Lottenburger², I. Hansen², L. S. Andersen², U. Tarp², H. Skjødt², J. Pedersen², O. Majgaard², A. J. Svendsen², T. Ellingsen², H. M. Lindegaard², J. Vallø², T. Torfing², H. S. Thomsen², A. F. Christensen², K. Hørslev-Petersen^2
1Dept of Rheumatology, Copenhagen University Hospital, Hvidovre, ²Rheumatology and Radiology Depts, University hospitals of, Copenhagen, Århus, South Denmark, Denmark

Objectives: To identify predictors of radiographic progression in a 5-year randomized, clinical trial (RCT) of patients with very early (<6 months’ duration), DMARD naive, active rheumatoid arthritis (RA). We have previously identified the magnetic resonance imaging (MRI) bone oedema score to be a significant predictor of radiographic progression at 2 years of follow-up (1).

Methods: In 77 patients, participating in a double-blind, placebo-controlled RCT (the CIMESTRA study (2-3)), baseline clinical/biochemical disease activity measures (incl. disease activity score (DAS28), MRI of the non-dominant wrist and metacarpophalangeal (MCP)-joints (scored according to the OMERACT RAMRIS), conventional x-rays of hands, wrists and forefeet (Sharp/van der Heijde method), serum anti-cyclic citrullinated peptide antibodies (anti-CCP), and serum rheumatoid factor (IgM RF) were available. Patients were treated aggressively with disease-modifying anti-rheumatic drugs (DMARD): methotrexate, intra-articular betamethasone and cyclosporine/placebo-cyclosporine, aiming at clinical remission. A multiple regression analysis with stepwise backward selection was performed with delta Total Sharp/van der Heijde Score (TSS) from 0 to 5 years as the dependent variable. Possible predictive baseline variables were tested: TSS, DAS28, MRI bone oedema score, MRI synovitis score, MRI erosion score, anti-CCP, age, gender.

Results: At baseline, the median DAS28 was 5.6 (range 2.4-8.0), 62% were IgM RF positive, 60% were anti-CCP positive, and 56% had radiographic erosions. After 5 years, DAS28 was 2.0 (1.0-5.2), 75% were in DAS-remission, and 49% had progressed radiographically. Baseline MRI bone oedema score (p<0.0001) and TSS (p<0.05) were significant predictors of radiographic progression after 5 years, while the other variables did not reach statistical significance (table). MRI bone oedema score explained 31% of the variation in the progression of radiographic score (Pearson's r=0.56).

Table:

Conclusion: In early RA patients treated aggressively in a RCT with DMARDs and intraarticular corticosteroids aiming at remission, the OMERACT MRI bone oedema score of MCP and wrist joints at baseline was a strong independent predictor of radiographic progression (increase in TSS) in hands, wrists and feet during the subsequent 5 years. TSS was also a significant predictor, whereas MRI synovitis score, MRI erosion score, DAS28, anti-CCP and IgM RF were not independent risk factors for radiographic progression.

References: 1. Ann Rheum Dis. Epub 2008 April 35.
2. Arthritis Rheum. 2006; 54:1401-9.
3. Ann Rheum Dis 2008; 67: 815-822

Disclosure of Interest: None declared.