SP0209 Technical Validity of MRI for Evaluating Joint Damage and Inflammation in Rheumatoid Arthritis
M. Østergaard
Jun 1, 2014
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Annals of the Rheumatic Diseases
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Key Takeaway Key Takeaway: MRI, with the OMERACT RAMRIS system, providing a reliable and sensitive method for monitoring joint inflammation and damage in RA patients.
Abstract
Magnetic resonance imaging (MRI) allows quantitative (volume or, for synovitis, early contrast enhancement after intravenous contrast injection) as well as less detailed (qualitative: presence/absence; semiquantitative: scoring) evaluation of synovitis, bone edema (osteitis) and bone erosions. In observational and randomized clinical trials, semiquantitative scoring by the OMERACT (Outcome Measures in Rheumatology) RA MRI scoring system (RAMRIS) has been the most frequently used system. It involves semiquantitive assessment of synovitis, bone erosions and bone edema in RA hands and wrists, based on consensus MRI definitions of important joint pathologies and a “core set” of basic MRI sequences [1]. The OMERACT erosion scores are closely correlated with erosion volumes estimated by MRI and CT, and MRI assessment of synovitis and osteitis correlates well with findings at miniarthroscopic and histological findings [2–4]. Good intra- and inter-reader reliability and a high sensitivity to change has been reported [5]. Thus, the OMERACT RAMRIS system, after proper training and calibration of readers, is suitable for monitoring joint inflammation and destruction in RA. A EULAR-OMERACT RA MRI reference image atlas has been developed, providing a easy-to-use tool for standardized RAMRIS scoring of MR-images for RA activity and damage by comparison with standard reference images [6]. An MRI joint space narrowing scoring system, which is planned to be used to assess cartilage damage as an adjunct to the RAMRIS system, has been developed [7,8]. MRI findings have been shown to predict subsequent radiographic progression [9–12]. The RAMRIS is now used as the routine MRI method in clinical trials [13,14], allowing more sensitive monitoring of inflammation and damage than clinical and radiographic assessments. As an example, a large study of 318 methotrexate-naïve patients demonstrated that inhibition of erosive progression by biological therapy compared to placebo can be demonstrated by MRI using ½ the patients and ½ the follow-up time as by radiography [15]. Based on evidence from multiple observational studies and several randomized controlled trials (RCTs), it can be concluded that MRI meets the OMERACT validation filter for truth, discrimination, and feasibility in RCTs in RA. References Østergaard M et al. J Rheumatol 2003; 30: 1385-1386. Døhn UM et al. Arthritis Res Ther 18-7-2006; 8: R110- Døhn UM et al. Ann Rheum Dis 2007; 66: 1388-1392. Døhn UM et al. Arthritis Res Ther 2008; 10: R25 Haavardsholm EA et al. Arthritis Rheum 2005; 52: 3860-3867. Østergaard M et al. Ann Rheum Dis 2005; 64 Suppl 1: i2-i55. Østergaard M et al. J Rheumatol 2011; 38: 2045-2050. Døhn UM et al. J Rheumatol 2014; 41: 392-397. Hetland ML et al. Ann Rheum Dis 2009; 68: 384-390. Hetland ML et al. Ann Rheum Dis 2010; 69: 1789-1795. Haavardsholm EA et al. Ann Rheum Dis 2008; 67: 794-800. Baker JF et al. Ann Rheum Dis 2013 (Published Online). Peterfy C et al. Ann Rheum Dis 2013; 72: 794-796. American College of Rheumatology Rheumatoid Arthritis Clinical Trials Task Force Imaging Group and Outcome Measures in Rheumatology Magnetic Resonance Imaging Inflammatory Arthritis Working Group. Arthritis Rheum 2013; 65: 2513-2523. Østergaard M et al. Arthritis Rheum 2011; 63: 3712-3722. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6327