Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Discriminative Power of Different Combinations of Bones and Joints for Assessing Change in Rheumatoid Arthritis with MRI: Results Based on Pooled Data from Four Multisite Clinical Trials.

Peterfy8,  Charles G., Countryman7,  Peter, DiCarlo7,  Julie, Gabriele4,  Annarita, Shaw3,  Tim M., Anisfeld5,  Andrew, Tsuji1,  Wayne H.

Amgen, Seattle, WA
Arthritis & Rheumatic Disease, Aventura, FL
F Hoffmann La-Roche, Ltd, Welwyn Gladen City Herts, United Kingdom
F Hoffmann La-Roche, Ltd, Italy
Genentech, a Member of the Roche Group
Oklahoma Medical Research Foundation, Oklahoma City, OK
Spire Sciences, LLC, San Francisco, CA
Spire Sciences, LLC, Kentfield, CA

Background:

We previously showed that different combinations of bones and joints in the hand and wrist varied in their ability to discriminate significant change in synovitis, osteitis and erosion with MRI in patients wtih RA in a multicenter clinical trial1. In this study, we corroborated these findings using pooled data from 4 multisite clinical trials.

Methods:

A total of 522 RA patients from 4 clinical trials were included in the analysis. Three of these studies (459 patients) included 1.5T MRI, and 2 studies (118 patients) included 0.2T MRI. All scans used a hand frame to ensure reproducible positioning, and were read by the same 2 radiologists. Metacarpophalangeal joints (MCP) 1–5 and all bones and joints in the wrist were scored using the RAMRIS scale2 for erosion and osteitis in all 4 trials and synovitis in all but one of the 1.5T trials. Six combinations (RAMRIS, 23 bones and 7 joints in original RAMRIS; RAMRIS+, RAMRIS + MCP1; V-Sharp, MCP1–5 + 6 wrist bones in van der Heijde-Sharp X-ray score; G-Sharp, MCP1–5 + 5 wrist bones in Genant-Sharp X-ray score [V-Sharp – lunate]; MCPs, MCP1–5; Wrist, 15 bones and 3 joints in RAMRIS) were compared for percentages of patients changing (increase or decrease) >= smallest detectable change (SDC)3 at week 12 or 24.

Results:

Frequency of involvement at baseline varied by location (Fig.1), but showed a similar pattern in all 4 studies and between patients with early (<2y) RA and those with established (>10y) RA (data not shown). Inter-reader agreement, expressed as intraclass correlation coefficient (ICC), also varied among locations (median = 0.84, 0.88 and 0.81, for erosion, osteitis and synovitis, respectively.) Percent of patients changing >=SDC at 12 or 24 weeks varied among the different combinations (Fig. 2). Adding MCP-1 to RAMRIS (RAMRIS+) increased discrimination for erosion and synovitis. G-Sharp showed the highest discrimination for osteitis and synovitis, and was equivalent to RAMRIS for erosion. Excluding all wrist locations (leaving only MCPs) actually increased discrimination for erosion over that with RAMRIS, but decreased discrimination for osteitis or synovitis.

Figure 1. Frequency of involvement of different bones and joints of MCPs and wrist with erosion, osteitis and synovitis (RAD, radius; ULN, ulna; SCAP, scaphoid; TRIQ, triquetrum; PIS, pisiform; TPM, trapezium; TPD, trapezoid; CAP, capitate; HAM, hamate; PMC, proximal metacarpal; DMC, distal metacarpal; PP, proximal phalanx; DRU, distal radioulnar joint; RC, radiocarpal joint; ICMC, intercarpal and carpometacarpal 2-5.)

Figure 2. Proportion of patients showing change (increase or decrease) from baseline in erosion, osteitis or synovitis scores >=±SDC for different combinations.

Conclusions:

Filtering out noisy and infrequently involved bones and joints may improve discriminative power of RAMRIS. Determining the combination that optimally balances functional relevance with reading reliability requires further investigation.

1. Peterfy C, et al. EULAR 2010

2. Ostergaard M, et al. Ann Rheum Dis 2005;64(Suppl1):i3–i7

3. Bruynesteyn K et al. Ann Rheum Dis 2005;64:179–82

To cite this abstract, please use the following information:
Peterfy, Charles G., Countryman, Peter, DiCarlo, Julie, Gabriele, Annarita, Shaw, Tim M., Anisfeld, Andrew, et al; Discriminative Power of Different Combinations of Bones and Joints for Assessing Change in Rheumatoid Arthritis with MRI: Results Based on Pooled Data from Four Multisite Clinical Trials. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :125
DOI: 10.1002/art.27894

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