MRI Bone Edema Is an Independent Predictor of Development of Rheumatoid Arthritis in Patients with Early Undifferentiated Arthritis.
[133] - MRI Bone Edema Is an Independent Predictor of Development of Rheumatoid Arthritis in Patients with Early Undifferentiated Arthritis.
Anne Duer-Jensen, MD1,Kim Hørslev-Petersen2,Merete L Hetland, MD, PhD3,Lene Bak, MD4,Bo J Ejbjerg5,Michael S Hansen6,Julia S Johansen7,Hanne M Lindegaard, MD, PhD8,Henrik Vinterberg9,Jakob M Møller, MSc10,Mikkel Ostergaard11. 1Dept of Rheumatology, Copenhagen University Hospital at Glostrup and Hvidovre,2King Christian Xth Hospital for Rheumatic Diseases, Gråsten,3Rheumatology 232, Copenhagen Univ Hosp Hvidovre and Glostrup, Hvidovre,4Dept of Radiology, Sygehus Lillebælt, Kolding,5Dept of Rheumatology, Slagelse Hospital,6Dept of Rheumatology, Copenhagen University Hospital at Gentofte,7Dept of Oncology, Copenhagen University Hospital at Herlev,8Dept of Rheumatology, Odense University Hospital,9Rheumatology Clinic, Amagerbrogade, Copenhagen,10Dept of Radiology, Copenhagen University Hospital at Herlev,11Copenhagen University Hospitals at Hvidovre and Glostrup, Hvidovre
Objectives: To study magnetic resonance imaging (MRI) as a tool for early diagnosis of rheumatoid arthritis (RA) in patients with early undifferentiated arthritis (UA).
Methods: 116 patients without a specific rheumatological diagnosis, but with >2 tender and/or swollen metacarpophalangeal, proximal interphalangeal, wrist or metatarsophalangeal (MTP) joints for >6 weeks but <24 months, underwent clinical, biochemical, conventional radiography and MRI examinations (qualitatively assessed for various pathologies and according to the OMERACT RAMRIS scoring method (CMC1 and MTP1 joints excluded)) and were followed for >12 months for final RA/non-RA diagnosis.
Based on univariate analyses, clinical, biochemical and imaging parameters were selected as explanatory variables in multiple logistic regression analysis with development of RA as dependent variable.
Results: 27 patients (23.3%) developed RA. The gender distribution and median age in the RA/non-RA groups were 81.5/76.4% women and 50 yrs (range 21-80)/47 yrs (19-82), respectively, and the symptom duration 4 mth (2-18)/7 mth (1.5-24). The final prediction model, consisting of presence of hand arthritis, positive rheumatoid factor (RF), morning stiffness >1 hour and OMERACT sum score of bone edema in MTP and wrist joints, correctly identified 82% of patients, who eventually developed RA or not RA (sensitivity/specificity: 81%/82%) (table, model 1). An alternative model (table, model 2), in which OMERACT sum score of bone edema in MTP and wrist joints was replaced by OMERACT sum score of bone edema in MTP, wrist and PIP joints, confirmed bone edema as independent predictor.
Conclusion: MRI bone edema in MTP and wrist joints is an independent predictor of future RA in patients with early UA. A prediction model, including clinical hand arthritis, morning stiffness, positive RF and MRI bone edema score in MTP and wrist joints correctly identified the development of RA or non-RA in 82% of patients.
Keywords: rheumatoid arthritis (RA), magnetic resonance imaging (MRI), diagnosis, RA prediction model
Disclosure:
- Anne Duer-Jensen:
Nothing to disclose. - Kim Hørslev-Petersen:
Abbott Laboratories: Consulting fees
Bristol-Myers Squibb: Consulting fees
Roche: Consulting fees - Merete Hetland:
Abbott Laboratories: Research grants
Bristol-Myers Squibb: Research grants
Centocor, Inc.: Research grants
Pfizer Inc: Research grants, Consulting fees
Roche: Research grants, Consulting fees
UCB, Inc.: Research grants - Lene Bak:
Nothing to disclose. - Bo Ejbjerg:
Nothing to disclose. - Michael Hansen:
Roche: Non-remunerative positions of influence
UCB, Inc.: Non-remunerative positions of influence - Julia Johansen:
Nothing to disclose. - Hanne Lindegaard:
Abbott Laboratories: Consulting fees
Roche: Consulting fees - Henrik Vinterberg:
Nothing to disclose. - Jakob Møller:
Nothing to disclose.
Mikkel Ostergaard:
Nothing to disclose.