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.


Synovitis and Osteitis Is Very Frequent in Rheumatoid Arthritis (RA) Patients in Clinical Remission: Results from a MRI Study of 300 RA Patients in Clinical Remission or Low Disease Activity State.

Gandjbakhch5,  Frederique, Conaghan12,  Philip G., Ejbjerg2,  Bo, Haavardsholm3,  Espen, Foltz6,  Violaine, Brown12,  Andrew, Dohn11,  Uffe Moller

Chapel Allerton Hospital, Leeds, United Kingdom
Univ of Auckland Sch of Med, Auckland, New Zealand
University Hospitals at Hvidovre and Glostrup, Denmark
University of Leeds, Leeds, UK
Copenhagen University Hospitals at Hvidovre and Glostrup, Denmark
Diakonhjemmet Hospital, University of Oslo, Oslo, Norway
Division of Medicine, University of NSW, Sydney Australia
Hôpital Pitié-Salpétrière, Université PARIS VI - UPMC, Paris, France
Hôpital Pitié-Salpétrière, Université PARIS VI-UPMC, Paris, France
Hvidovre University Hospital, Hvidovre, Denmark
King Christian X's Hospital for Rheumatic Diseases, University of Southern Denmark
St. George Hospital, University of NSW, Sydney, Australia

Background:

The OMERACT rheumatoid arthritis magnetic resonance imaging score (RAMRIS) has been validated for RA monitoring and has been demonstrated to be reliable, sensitive to change and discriminative. Structural progression may occur despite clinical remission. However, remission and low disease activity (LDA) are defined on clinical criteria, and MRI may reveal subclinical inflammation.

Objective:

To determine MRI characteristics of RA patients in clinical remission or LDA state.

Materials and Methods:

Databases issued from 6 different cohorts were collected from 5 centres. RA patients in clinical remission or LDA state (defined as DAS28-CRP < 3.2) with available MRI data were included. MRIs were assessed according to RAMRIS. Data were analysed using SAS software, version 9.1.

Results:

300 patients in clinical remission (219 patients) or LDA state (81 patients) were included. Patient characteristics: 69% female, age: median 55(IQR 43–63) years, disease duration 2.4(0.7–5.1) years, DAS28-CRP 2.2(1.7–2.6), SDAI: 3.9(1.9–6.5), CDAI: 3.1(1.5– 5.8), RF/anti-CCP positivity: 56%/54%, presence of radiographic erosions: 67 %. Wrist and MCP-MRI data were available for 287 patients and 247 patients respectively. MRI inflammatory activity was observed in the majority of patients, as synovitis and bone edema (osteitis) were observed in wrist or MCP joints in 95 % and 35% of the patients, respectively (figure1). The median (IQR) RAMRIS score for synovitis was 6(3–9) and for osteitis was 0(0–2).

The occurrence of synovitis and bone edema was not significantly different between patients in DAS28-clinical remission (synovitis/osteitis 96%/35%) and patients in LDA but not remission (synovitis/osteitis 91%/36%)(p=0.15/0.87). A trend towards lower frequencies of synovitis and osteitis in patients fulfilling more stringent remission criteria (SDAI and CDAI) was observed (data not shown).

Conclusion:

Subclinical inflammation was revealed by MRI in the majority of RA patients in clinical remission or LDA state. This may explain structural progression in such patients. It should be considered whether future remission criteria should include modern imaging.

To cite this abstract, please use the following information:
Gandjbakhch, Frederique, Conaghan, Philip G., Ejbjerg, Bo, Haavardsholm, Espen, Foltz, Violaine, Brown, Andrew, et al; Synovitis and Osteitis Is Very Frequent in Rheumatoid Arthritis (RA) Patients in Clinical Remission: Results from a MRI Study of 300 RA Patients in Clinical Remission or Low Disease Activity State. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :141
DOI: 10.1002/art.27910

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