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.


Magnetic Resonance Imaging Assessments of Patients with RA and Their Association with Clinical and Radiographic Outcomes.

Emery3,  Paul, Van Der Heijde6,  Desiree M., Ostergaard5,  Mikkel, Conaghan4,  Philip G., Genovese7,  Mark C., Keystone9,  Ed C., Fleischmann8,  Roy M.

Centocor Research and Development, Inc.
Centocor Research and Development, Inc./Univ. of Pennsylvania School of Medicine, Malvern, PA
Chapel Allerton Hospital, Leeds, United Kingdom
Chapel Allerton Hospital, Leeds, United Kingdom
Copenhagen University Hospital at Glostrup and Hvidovre
Leiden University Medical Center, Meerssen, The Netherlands
Stanford University, Sunnyvale, CA
University of Texas SW Medical Center, Dallas, TX
University of Toronto, Toronto, ON, Canada

Objective:

To evaluate the relationship between changes in inflammation and structural damage detected by MRI and clinical and radiographic outcomes in RA pts.

Methods:

Data from 2 large study populations were evaluated: 1) GO-BEFORE evaluated (MTX)-naïve pts with active RA and 2) GO-FORWARD evaluated pts with active RA despite MTX. In both studies, pts were randomly assigned to receive placebo(PBO)+MTX, GLM100mg+PBO, GLM50mg+MTX, or GLM100mg+MTX. GLM and PBO were administered SC q4wks. A subset of study sites capable and willing participated in MRI substudies. All pts from each site were eligible to participate in the substudies (n=318 GO-BEFORE; n=240 GO-FORWARD). MRIs of pt's dominant wrist and metacarpophalangeal joints were obtained at baseline and wks12,24,52&104. Results through wk24 are presented here. Images were scored by 2 independent expert readers blinded to image time point or sequence, pt identity, or treatment group. Readers scored synovitis(0–21), bone erosions(0–230), and bone edema(0–69) using Rheumatoid Arthritis MRI Scoring (RAMRIS) system. Preliminary assessments of relationships between RAMRIS system scores and clinical and radiographic measures were done using Spearman correlation coefficients. Disease activity was measured using 28-joint count Disease Activity Score calculated using CRP (DAS28-CRP). Structural damage was measured using the van der Heijde modification of the Sharp (vdH-S) score.

Results:

Analysis results are summarized in the Table. In both studies, statistically significant correlations were observed between baseline synovitis, bone edema, and bone erosion scores and baseline vdH-S scores; strongest correlations were between baseline RAMRIS bone erosion and baseline vdH-S scores. Changes in DAS28-CRP scores at wks12&24 correlated with changes at wks 12&24, respectively, in RAMRIS synovitis, RAMRIS bone edema (wk24 only), and RAMRIS erosion scores among MTX-naïve pts in GO-BEFORE, but only with changes at wks12&24, respectively, in RAMRIS synovitis and RAMRIS bone edema scores among MTX-inadequate responders in GO-FORWARD;correlations were generally weak or moderate. Percent changes from baseline in CRP levels correlated with changes in RAMRIS synovitis and RAMRIS bone edema scores at all time points but not with changes in RAMRIS bone erosion scores. Although statistically significant in both study populations, these correlations were generally weak or moderate. Correlations observed between changes in vdH-S scores and changes in RAMRIS synovitis, RAMRIS bone edema, and RAMRIS bone erosion scores were inconsistent and weak.

Conclusion:

Strong and significant correlations were observed between baseline MRI scores and baseline radiographic scores. Correlations observed between changes in RAMRIS scores and changes in clinical and radiographic measures were generally weak or moderate.

 GO-BEFOREGO-FORWARD
 SynovitisBone EdemaBone ErosionsSynovitisBone EdemaBone Erosions
Baseline RAMRIS vs:      
  Baseline vdH-S0.26 (p<0.001)0.49 (p<0.001)0.64 (p<0.001)0.28 (p<0.001)0.53 (p<0.001)0.77 (p<0.001)
RAMRIS D to wk 12 vs:      
  CRP %D to wk 4-0.17 (p=0.010)-0.13 (p=0.040)-0.005 (p=0.94)-0.23 (p=0.002)-0.19 (p=0.007)0.06 (p=0.39)
  CRP %D to wk 12-0.21 (p=0.002)-0.19 (p=0.002)-0.05 (p=0.45)-0.22 (p=0.005)-0.20 (p=0.006)-0.04 (p=0.54)
  DAS28 D to wk 120.23 (p<0.001)0.18 (p=0.004)0.14 (p=0.029)0.16 (p=0.040)0.22 (p=0.002)0.02 (p=0.80)
  DAS28 D to wk 240.92 (p=0.10)0.96 (p=0.20)0.93 (p=0.92)0.89 (p=0.09)0.92 (p=0.049)1.04 (p=0.20)
  vdH-S D to wk 24/280.08 (p=0.22)0.14 (p=0.033)0.05 (p=0.48)0.16 (p=0.07)0.10 (p=0.23)-0.18 (p=0.027)
RAMRIS D to wk 24 vs:      
  CRP*%D to wk 24-0.20 (p=0.002)-0.25 (p<0.001)-0.06 (p=0.34)-0.32 (p<0.001)-0.22 (p=0.007)-0.03 (p=0.69)
  DAS28 D to wk 240.23 (p<0.001)0.15 (p=0.017)0.17 (p=0.006)0.36 (p<0.001)0.21 (p=0.008)0.10 (p=0.22)
  vdH-S D to wk 24/280.13 (p=0.06)0.07 (p=0.31)0.03 (p=0.63)0.12 (p=0.22)0.16 (p=0.09)-0.06 (p=0.50)

To cite this abstract, please use the following information:
Emery, Paul, Van Der Heijde, Desiree M., Ostergaard, Mikkel, Conaghan, Philip G., Genovese, Mark C., Keystone, Ed C., et al; Magnetic Resonance Imaging Assessments of Patients with RA and Their Association with Clinical and Radiographic Outcomes. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1114
DOI: 10.1002/art.28881

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