REMISSION PLUS: Multicenter Evaluation of Low-Field MRI for Monitoring Treatment Response in Rheumatoid Arthritis Patients.

1.      [138] - REMISSION PLUS: Multicenter Evaluation of Low-Field MRI for Monitoring Treatment Response in Rheumatoid Arthritis Patients.

Ben Ostendorf, MD1,Sabine Kamp, medical student1,Birthe Koerbl2,Dorothea Reichelt, MD3,Klaus Strassburger, Dr.2,Axel Scherer, MD3,Sabine Blaschke, MD4,Edmund Edelmann, MD5,Ino Gao6,Gernot Keyßer, MD7,Hans-Martin Lorenz, MD8,Ulf Müller-Ladner, MD9,Hans-Georg Pott10,Marisa Walther, MD11,Matthias Schneider, MD12. 1Rheumatology, Department of Endocrinology, Diabetology and Rheumatology, Rhine-Ruhr Rheumatology Center, Heinrich-Heine-University Düsseldorf, Düsseldorf, NRW,2German Diabetes Center at the Heinrich-Heine-University Düsseldorf, Leibniz Center for Diabetes Research, Institute of Biometrics and Epidemiology, Düsseldorf, NRW,3Department of Radiology, Heinrich-Heine-University Düsseldorf, Düsseldorf, NRW,4Rheumatology, Göttingen University Hospital, Göttingen,55 Rheumatology Office, Bad Aibling, Bad Aibling,6Rheumatology Office, Heidelberg, Heidelberg,7Rheumatology, Martin Luther University, Halle-Wittenberg, Halle,8Rheumatology Department, Heidelberg University Hospital, Heidelberg,9Rheumatology, Kerckhoff Clinic, Bad Nauheim, Bad Nauheim,10Rheumatology Center, Hannover, Hannover,11Rheumatology Clinic, Berlin-Buch, Berlin,12Rheumatology, Department of Endocrinology, Diabetology and Rheumatology, Rhine-Ruhr Rheumatology Center, Heinrich-Heine-University Düsseldorf,, Düsseldorf, NRW

Objective: Multicenter evaluation of low-field MRI as a tool for monitoring treatment response in patients with rheumatoid arthritis (RA) on the REMISSION PLUS pilot project.

Methods: RA patients initiating treatment with a DMARD or biologic at 9 sites throughout Germany underwent low-field MRI (C-scan, Esaote, 0.2 T) of the clinically dominant hand at time points T0 (baseline), T1 (3 months) and T2 (6 to 12 months). The images were evaluated semiquantitatively using the RAMRIS scoring system and correlated with clinical and lab chemistry markers.

Results: 206 RA patients (T0), 58 = m, 148 = f, age (years): (mean=55.87, min.19, max. 84), time since diagnosis: (median=20.32 months, min. 0.2 months, max. 45 years), DAS28 (mean = 4.83, 2.1 - 8), rheumatoid factor positive n = 118, CCP antibody positive n = 118, treatment naive: n = 64, switching treatments: n = 187; MRI follow-up at 3 months (T1) and at 6 to 12 months (T2); T0 and T2: n=96; T0, T1 and T2: n=55. RAMRIS (T0-T1-T2): 41.58-29.62-21.91 ; MCP: 13.31-8.76-6.38; wrist: 28.19-20.74-15.50; synovitis score (MCP): 5.11-3.06-1.60; wrist: 4.47-3.64-2.54; edema score (MCP): 2.85-1.74-0.91; wrist: 10.04-5.60-2.91; erosion score (MCP): 5.35-4.13-3.87; wrist: 13.68-11.49-10.06; SRM (standardized response mean (> 0.5 moderate potential to detect changes)) T0-T2 synovitis: 0.999 (MCP); 0.709 (wrist), edema: 0.702 (MCP); 0.792 (wrist); p-correlations T0-DAS28 for synovitis: 0.010 (MCP); 0.037 (wrist); for edema: 0.507 (MCP); 0.049 (wrist); T0-CRP for synovitis: 0.538 (MCP); 0.276 (wrist); for edema: 0.154 (MCP); 0.011 (wrist).

Conclusions: Low-field MRI is a sensitive imaging method and RAMRIS a practicable scoring system for morphological and semiquantitative evaluation of therapeutic response to real-life rheumatologic care in significant correlation to clinical and lab data. The added benefit of low-field MRI is that it provides in-depth information on the severity of synovitis, edema (significant reduction on treatment) and erosion during follow-up, hence enabling early identification of responders/non-responders and providing a basis for individual prediction of prognosis and optimal disease management.
The project is supported by Abbott Immunology and Esaote Biomedica Deutschland GmbH.

Keywords: imaging techniques, magnetic resonance imaging (MRI), rheumatoid arthritis (RA), low-field MRI, remission, therapy monitoring

Disclosure:

  • Ben Ostendorf: Nothing to disclose.
  • Sabine Kamp:  Nothing to disclose.
  • Birthe Koerbl:  Nothing to disclose.
  • Dorothea Reichelt:  Nothing to disclose.
  • Klaus Strassburger:  Nothing to disclose.
  • Axel Scherer:  Nothing to disclose.
  • Sabine Blaschke:  Nothing to disclose.
  • Edmund Edelmann:  Nothing to disclose.
  • Ino Gao:  Nothing to disclose.
  • Gernot Keyßer:  Nothing to disclose.
  • Hans-Martin Lorenz: Nothing to disclose.
  • Ulf Müller-Ladner: Nothing to disclose.
  • Hans-Georg Pott: Nothing to disclose.
  • Marisa Walther:  Nothing to disclose.
  • Matthias Schneider:  Nothing to disclose.