PROJECT REMISSIONPLUS: CLINICAL AND RADIOLOGICAL REMISSION. EVALUATION OF A MULTICENTER LOW-FIELD MRI STUDY
4. [OP-0056] PROJECT REMISSIONPLUS: CLINICAL AND RADIOLOGICAL REMISSION. EVALUATION OF A MULTICENTER LOW-FIELD MRI STUDY
B. Ostendorf*1, S. Kamp1, A. Scherer2, D. Reichelt2, H. Burkhardt3, E. Edelmann4, H. Euler5, I. Gao6, G. Key er7, A. Krause8, H. Lorenz9, G. Müller10, U. Müller-Ladner11, M. Schneider1
1Endocrinology, Diabetology and Rheumatology, 2Institute for Radiology, Heinrich-Heine University Düsseldorf, Düsseldorf, 3Dept. of Rheumatology, University Frankfurt, Frankfurt, 4Rheumatology, Privat Practise, Bad Aibling, 5Rheumatology, Privat Practise, Hamburg, 6Rheumatology, Privat Practise, Heidelberg, 7Dept. of Rheumatology, University Halle, Halle, 8Dept. of Rheumatology, Berlin-Buch, Berlin, 9Dept. of Rheumatology, University Heidelberg, Heidelberg, 10Dept. of Rheumatology, University Göttingen, Göttingen, 11Dept. of Rheumatology, University Giessen, Giessen, Germany
Background: The RemissionPlus Project includes nationwide the setting up of 8 specialized centres of excellence in various imaging procedures such as high-resolution arthrosonography und and low-field (extremity) magnetic resonance imaging (E-MRI). Main areas of RemissionPlus focus on implementation of educational programs and training seminars, development and establishment of standardized documentation (modification of RAMRIS) and systematic monitoring of patients on treatment.
Objectives: Analysis of E-MRI data (modified RAMRIS for hand and/or foot) of patients with rheumatoid arthritis (RA) and Psoriatic Arthritis (PsoA) under DMARD and biologicals at 0,3,6,12 months in a prospective multicenter study in correlation to serological, clinical and radiological parameters.
Methods: In 8 centres RA and PsoA patients were investigated by E-MRI (C-Scan, Esoate, 0.2 Tesla; standardized MRI protocol, dominant hand or foot) before and after therapy with DMARD and/or biologicals at T0, T1 (after 3 months), T2 (after 6 months), and T3 (after 12 months). E-MR images were scored semi-quantitatively using a modified RAMRIS, incl. bone marrow edema (BME), synovitis and erosion. MRI data were correlated with clinical (DAS 28) and serological data (ESR, CRP, CCP, RF) and conventional radiological findings (hands and feet; presence of erosions at T0 and the development after 12 months (T3)).
Results: MRI data of T0-T2 were presented (T3 = study ongoing: RA (n=70), PsoA (n=15); n = 65 (T0,T1), n = 50 (T0-T2); 60% female, 40% male, mean-age: 56 years, mean-disease duration: 4 yrs., 47% rheumatoid factor positive, 44 % CCP positive; mean-DAS28 (T0) = 4.4; no DMARD at T0 (n=35), DMARD, DMARD change/or change to biological after T0 (n=50); ESR (mm/h): 27 (T0), 16 (T1), 14 (T2), CRP (mg/l): 11(T0), 7 (T1), 5 (T2); DAS 28: 4,4 (T0), 3,4 (T1), 3,1 (T2); RAMRIS (hand): 32,5 (T0), 30,4 (T1), 29,4 (T2); RAMRIS (MCP): 11,4 (T0), 10,3 (T1), 9,1 (T2); RAMRIS (wrist): 21,8 (T0), 20,7 (T1), 20,1 (T2), Synovitis-Score (MCP): 4,4 (T0), 3,8 (T1), 3,1 (T2), BME-Score (MCP): 2,8 (T0), 1,9 (T1), 1,2 (T2); Synovitis-Score (wrist): 4,6 (T0), 3,2 (T1), 3,9 (T2), BME-Score (wrist): 5,3 (T0), 4,8 (T1), 4,1 (T2).
Conclusion: The RemissionPlus Project presents a longitudinal multicenter study of therapy-monitoring by E-MRI, introducing the RAMRIS (modified version) as a practicable system under clinical and routine conditions. Parts of RAMRIS, reflecting inflammation, were highly sensitive and responsive during DMARD and biological treatment correlating with clinical and serological parameters.
References: Ostendorf B et al.; Project REMISSION(PLUS): clinical and radiological remission : New treatment goals in the management of rheumatoid arthritis.]
Z Rheumatol 2008;67:707-15.
Disclosure of Interest: Project RemissionPlus is supported by Abbott Immunology and Esaote Biomedica Deutschland GmbH.