Abstract 956 Magnetic Resonance Scanning at First Presentation Predicts odified Sharp Score at Six Years in Patients with Rheumatoid Arthritis
Benton, Perry, Crabbe, Stewart, Robinson, Yeoman, McQueen. Auckland, New Zealand.

Magnetic Resonance (MR) Scanning can detect synovitis, tendonitis, bone edema and bone erosions earlier than xray or physical examination. This study examined the positive predictive value of MR findings in early RA for later erosions.

Methods: 42 RA patients with disease less than 6 months were followed for 6 years with MR scanning and xrays of the dominant wrist. The results for the first 20 patients were presented.

Results: Inter-reader reliability at 6 years for xrays and MR scans was high (ICC scores 0.92 and 0.86 respectively). Total MR scores and Sharp scores also correlated significantly at 6 years. Bone edema, but not synovitis or tendonitis, was a significant predictor for subsequent bone erosions (OR 8.5 [95% CI 2.79, 34.9]). In regression models to determine which baseline MR parameters were predictive of 6-year XR measures, the sum of baseline erosions and bone edema scores were highly predictive of the total Sharp score (p=0.005) and the dominant wrist Sharp score (p<0.0001).

Conclusions: Bone edema and erosions by MR scan can predict future radiographic damage. This may allow disease-modifying therapy to be targeted more accurately to those patients with aggressive disease.

Editorial Comments: This is an interesting finding and suggests that erosion of bone may originate within the bone itself (e.g., islands of activated osteoclasts) rather than by invading synovium. It also suggests that we may be able to identify aggressive (erosive) disease earlier by MR scan than by routine hand/foot radiographs.

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