TY - JOUR
T1 - MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2 year randomized controlled trial (CIMESTRA)
AU - Hetland, Merete Lund
AU - Ejbjerg, Bo Jannik
AU - Hørslev-Petersen, Kim
AU - Jacobsen, Søren
AU - Vestergaard, Aage
AU - Jurik, Anne Grethe
AU - Stengaard-Pedersen, Kristian
AU - Junker, Peter
AU - Lottenburger, Tine
AU - Hansen, Ib
AU - Andersen, Lis Smedegaard
AU - Tarp, Ulrik
AU - Skjødt, Henrik
AU - Pedersen, Jens K
AU - Majgaard, Ole
AU - Svendsen, Anders J
AU - Ellingsen, Torkell
AU - Lindegaard, Hanne M
AU - Christensen, Anne F
AU - Vallø, Jørgen
AU - Torfing, Trine
AU - Narvestad, Eva
AU - Thomsen, Henrik S
AU - Østergaard, Mikkel
PY - 2009
Y1 - 2009
N2 - OBJECTIVE: To identify predictors of radiographic progression in a 2-year randomized, double-blind clinical study (CIMESTRA) of patients with early rheumatoid arthritis (RA). METHODS: Early RA patients (N=130) were treated with methotrexate, intra-articular betamethasone and cyclosporine/placebo-cyclosporine. Baseline magnetic resonance imaging (MRI) of the wrist (wrist-only-group:N=130) or MRI of wrist and MCP-joints (wrist+MCP-group:N=89) (OMERACT RAMRIS), x-rays of hands, wrists and forefeet (Sharp/vdHeijde Score (TSS)), disease activity score (DAS28), anti-cyclic-citrullinated-peptide-antibodies (anti-CCP), HLA-DRB1-shared-epitope (SE) and smoking status were assessed. Multiple regression analysis was performed with delta-TSS (0-2 years) as dependent variable, and baseline DAS28, TSS, MRI bone oedema score, MRI synovitis score, MRI erosion score, anti-CCP, smoking, SE, age and gender as explanatory variables. RESULTS: Baseline values: median DAS28: 5.6 (range: 2.4-8.0); anti-CCP positive: 61%; radiographic erosions: 56%. At 2 years: DAS28: 2.0 (0.5-5.7), in DAS-remission: 56%, radiographic progression: 26% (wrist+MCP-group, similar for wrist-only-group). MRI bone oedema score was the only independent predictor of delta-TSS (wrist+MCP-group: coefficient=0.75 (95%CI: 0.56-0.97), p<0.00001; wrist-only-group: coefficient=0.56 (0.41-0.77), p<0.00001). Bone oedema score explained 41% of the variation in the progression of TSS (wrist+MCP-group), 25% in wrist-only-group, (Pearson's r=0.64 and r=0.50, respectively). The results were confirmed by sensitivity analyses. CONCLUSION: In a RCT aiming at remission in early RA patients, baseline RAMRIS MRI bone oedema score of MCP and wrist joints (and of wrist only) was the strongest independent predictor of radiographic progression in hands, wrists and forefeet after 2 years. MRI synovitis score, MRI erosion score, DAS28, anti-CCP, SE, smoking, age and gender were not independent risk factors.
AB - OBJECTIVE: To identify predictors of radiographic progression in a 2-year randomized, double-blind clinical study (CIMESTRA) of patients with early rheumatoid arthritis (RA). METHODS: Early RA patients (N=130) were treated with methotrexate, intra-articular betamethasone and cyclosporine/placebo-cyclosporine. Baseline magnetic resonance imaging (MRI) of the wrist (wrist-only-group:N=130) or MRI of wrist and MCP-joints (wrist+MCP-group:N=89) (OMERACT RAMRIS), x-rays of hands, wrists and forefeet (Sharp/vdHeijde Score (TSS)), disease activity score (DAS28), anti-cyclic-citrullinated-peptide-antibodies (anti-CCP), HLA-DRB1-shared-epitope (SE) and smoking status were assessed. Multiple regression analysis was performed with delta-TSS (0-2 years) as dependent variable, and baseline DAS28, TSS, MRI bone oedema score, MRI synovitis score, MRI erosion score, anti-CCP, smoking, SE, age and gender as explanatory variables. RESULTS: Baseline values: median DAS28: 5.6 (range: 2.4-8.0); anti-CCP positive: 61%; radiographic erosions: 56%. At 2 years: DAS28: 2.0 (0.5-5.7), in DAS-remission: 56%, radiographic progression: 26% (wrist+MCP-group, similar for wrist-only-group). MRI bone oedema score was the only independent predictor of delta-TSS (wrist+MCP-group: coefficient=0.75 (95%CI: 0.56-0.97), p<0.00001; wrist-only-group: coefficient=0.56 (0.41-0.77), p<0.00001). Bone oedema score explained 41% of the variation in the progression of TSS (wrist+MCP-group), 25% in wrist-only-group, (Pearson's r=0.64 and r=0.50, respectively). The results were confirmed by sensitivity analyses. CONCLUSION: In a RCT aiming at remission in early RA patients, baseline RAMRIS MRI bone oedema score of MCP and wrist joints (and of wrist only) was the strongest independent predictor of radiographic progression in hands, wrists and forefeet after 2 years. MRI synovitis score, MRI erosion score, DAS28, anti-CCP, SE, smoking, age and gender were not independent risk factors.
U2 - 10.1136/ard.2008.088245
DO - 10.1136/ard.2008.088245
M3 - Journal article
C2 - 18388160
SN - 0003-4967
VL - 68
SP - 384
EP - 390
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
ER -