Prediction of joint damage through MRI in rheumatoid arthritis

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Prediction of joint damage through MRI in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory polyarthritis that often leads to progressive joint destruction and disability. The management of RA is often based on early identification of the disease and intervention with disease-modifying antirheumatic drugs (DMARDs). Nowadays, magnetic resonance imaging (MRI) is becoming an integral part of the rheumatologist's toolkit, both for assisting in the diagnosis of RA, also for monitoring disease progression and the response to therapy.

New research has found that MRI reveals RA changes in joint damage and inflammation as early as 12 weeks in a very short-duration than radiography (X-ray). These findings support the use of MRI as a valid method for monitoring structural damage.

The study published in the Annals of the Rheumatic Diseases was designed to evaluate the ability of early MRI findings to predict subsequent structural damage by X-ray. The data was from four randomised controlled trials involving 1022 patients in early and established RA and MRIs were scored using Outcome Measures in Rheumatology (OMERACT).

It was found that:

- Progression of MRI erosion scores at weeks 12 and 24 predicted progression of X-ray erosions at weeks 24 and 52, with areas under the curve (AUCs) of 0.64 and 0.74, respectively.

- 12-week and 24-week changes in MRI osteitis scores were similarly predictive of 24-week and 52-week X-ray erosion progressions; pooled AUCs were 0.78 and 0.77, respectively.

- MRI changes in synovitis at weeks 12 and 24 also predicted progression of X-ray joint damage (erosion and joint-space narrowing) at weeks 24 and 52 (AUCs=0.72 and 0.65, respectively).

According to Peterfy C, MD, Ph.D., founder and CEO of Spire Sciences Inc., in Boca Raton, Fla, "MRI is a valid imaging method for evaluating inflammation and joint damage in RA, and it detects changes in these disease features earlier than radiography does." He added, "MRI should be accepted for evaluating structure-modifying treatment efficacy in phase III clinical trials. The most recent regulatory guidance limits this to only 12 weeks. However, longer time intervals, i.e., 24 or more weeks are typically needed to discriminate a treatment effect reliably with radiography. This has created a demand for faster and more sensitive imaging tools for assessing disease progression and treatment response in RA."

Overall, the study adds to the evidence that MRI may fill the need for faster and more sensitive imaging tools, given its ability to discriminate treatment response concerning the same structural outcomes that radiography focuses on, but more quickly, often within only 12 weeks and with fewer patients.   Further, verifying treatment response, or lack of it, earlier and more accurately would allow more timely adjustment of therapy in treat-to-target management strategies, and presumably improve patient outcomes.


Annals of the Rheumatic Diseases

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Original title of the article:

MRI Predicts Joint Damage in Rheumatoid Arthritis

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