Abstract 2180: MRI Bone Edema is the Strongest Predictor of Subsequent Radiographic Progression in Early Rheumatoid Arthritis (RA). Results from a 2 Year Randomized Controlled Trial (CIMESTRA)
Authors
M. L. Hetland, B. Ejbjerg, M. Østergaard, S. Jacobsen, A. Vestergaard, A. G. Jurik, K. Stengaard-Pedersen, P. Junker, T. Lottenburger, I. Hansen, L. Smedegaard Andersen, U. Tarp, H. Skjødt, J. K. Pedersen, O. Majgaard, A. J. Svendsen, T. Ellingsen, G. Hansen, H. Lindegaard, J. Vallø, T. Torfing, H.S. Thomsen, K. H.-Petersen
Purpose:
To identify predictors of radiographic progression in patients with early RA.
Methods:
89 patients participating in a double-blind placebo-controlled trial (the CIMESTRA study) of early, active RA (< 6 months’ duration) were evaluated. Clinical and biochemical measures of disease activity, MRI of the non-dominant wrist and MCP joints, and xrays of the hands, wrists and feet were obtained. MRIs were scored according to the OMERACT RAMRIS. Treatment consisted of methotrexate, intraarticular betamethasone, and cyclosporine or placebo. Multiple regression analysis was employed with change in modified total Sharp score (TSS) from 0-2 yrs as the dependent variable.
Results:
Baseline median DAS28 was 5.6, 65% were IgM RF positive, 61% were anti-CCP positive, and 56% had erosions. At 2 yrs, median DAS28 had decreased to 2.0, and only 26% had progressed radiographically. The only independent predictor of change in TSS was the MRI bone edema score (P<0.00001). Bone edema explained 41% of the variation in progression of TSS (Pearson’s r=0.64). Other baseline factors that were not associated with change in TSS included DAS28, MRI synovitis and erosion scores, anti-CCP and RF, baseline TSS score, age, gender, treatment arm and cumulative steroid dose.
Conclusions:
In early RA patients treated aggressively in a randomized controlled trial, the MRI bone edema score, but not treatment arm or disease characteristics or other MRI scores, was an independent risk factor for radiographic progression.
Editorial Comment:
These results are consistent with other emerging data suggesting that bone “edema”, as detected by MRI, is frequently a precursor to joint damage (especially erosions). The word “edema” is probably a misnomer, and might be more properly called bone inflammation or fibrosis, as indicated by some histopathological analyses of these lesions. It is surprising that no other factors predicted radiographic progression such as treatment arm. However, one potential explanation is that the investigators aimed treatment towards remission and they were fairly successful. Thus, with so little radiographic progression, power to identify less potent predictive factors may have been fairly limited.
