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.


MRI Bone Edema Is an Independent Predictor of Development of Rheumatoid Arthritis in Patients with Early Undifferentiated Arthritis.

Duer-Jensen7,  Anne, Horslev-Petersen10,  Kim, Hetland1,  Merete L., Bak5,  Lene, Ejbjerg9,  Bo J., Hansen6,  Michael S., Johansen3,  Julia S.

Copenhagen Univ Hosp Hvidovre and Glostrup, Hvidovre, Denmark
King Christian Xth Hospital for Rheumatic Diseases, Gråsten
Rheumatology Clinic, Amagerbrogade, Copenhagen
Copenhagen University Hospitals at Hvidovre and Glostrup, Hvidovre, Denmark
Dept of Oncology, Copenhagen University Hospital at Herlev
Dept of Radiology, Copenhagen University Hospital at Herlev
Dept of Radiology, Sygehus Lillebælt, Kolding
Dept of Rheumatology, Copenhagen University Hospital at Gentofte
Dept of Rheumatology, Copenhagen University Hospital at Glostrup and Hvidovre, Denmark
Dept of Rheumatology, Odense University Hospital
Dept of Rheumatology, Slagelse Hospital

Objectives:

To study magnetic resonance imaging (MRI) as a tool for early diagnosis of rheumatoid arthritis (RA) in patients with early undifferentiated arthritis (UA).

Methods:

116 patients without a specific rheumatological diagnosis, but with >=2 tender and/or swollen metacarpophalangeal, proximal interphalangeal, wrist or metatarsophalangeal (MTP) joints for >6 weeks but <24 months, underwent clinical, biochemical, conventional radiography and MRI examinations (qualitatively assessed for various pathologies and according to the OMERACT RAMRIS scoring method (CMC1 and MTP1 joints excluded)) and were followed for >12 months for final RA/non-RA diagnosis.

Based on univariate analyses, clinical, biochemical and imaging parameters were selected as explanatory variables in multiple logistic regression analysis with development of RA as dependent variable.

Results:

27 patients (23.3%) developed RA. The gender distribution and median age in the RA/non-RA groups were 81.5/76.4% women and 50 yrs (range 21–80)/47 yrs (19–82), respectively, and the symptom duration 4 mth (2–18)/7 mth (1.5–24). The final prediction model, consisting of presence of hand arthritis, positive rheumatoid factor (RF), morning stiffness >1 hour and OMERACT sum score of bone edema in MTP and wrist joints, correctly identified 82% of patients, who eventually developed RA or not RA (sensitivity/specificity: 81%/82%) (table, model 1). An alternative model (table, model 2), in which OMERACT sum score of bone edema in MTP and wrist joints was replaced by OMERACT sum score of bone edema in MTP, wrist and PIP joints, confirmed bone edema as independent predictor.

Table. Baseline predictors of development of rheumatoid arthritis (logistic regression analysis)

VariableModel 1Model 2
 CoefficientOR (CI)p-valueCoefficientOR (CI)p-value
Arthritis of the hand2.36710.7 (2.9–39.7)<0.0012.30910.1 (2.7–37.4)0.001
Rheumatoid factor positive0.8816.6 (2.0–22.0)0.0011.8896.6 (2.0–21.0)0.002
> 1 hour of morning stiffness1.9977.4 (2.3–24.1)0.0011.9447.0 (2.3–22.9)0.001
OMERACT bone edema sum score in wrist+MTP joint areas (per unit)0.3651.4 (1.0–2.0)0.035
OMERACT bone edema sum score in wrist+MTP+PIP joint areas (per unit)0.3481.4 (1.0–2.0)0.046
Abbreviations: MTP=met at arsophalangeal, PIP=proximal interphalangeal, OR=Odds Ratio, CI=Confidence interval for OR.

Conclusion:

MRI bone edema in MTP and wrist joints is an independent predictor of future RA in patients with early UA. A prediction model,including clinical hand arthritis, morning stiffness, positive RF and MRI bone edema score in MTP and wrist joints correctly identified the development of RA or non-RA in 82% of patients.

To cite this abstract, please use the following information:
Duer-Jensen, Anne, Horslev-Petersen, Kim, Hetland, Merete L., Bak, Lene, Ejbjerg, Bo J., Hansen, Michael S., et al; MRI Bone Edema Is an Independent Predictor of Development of Rheumatoid Arthritis in Patients with Early Undifferentiated Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :133
DOI: 10.1002/art.27902

Abstract Supplement

Meeting Menu

2010 ACR/ARHP