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06-11-2019 | Rheumatology | News | Article

Early MRI changes in RA may predict long-term radiographic treatment response

medwireNews: Changes in joint erosion and osteitis, detected by magnetic resonance imaging (MRI) as early as 1 month after treatment initiation, may predict long-term radiographic progression in people with early, active rheumatoid arthritis (RA), research shows.

Philip Conaghan (University of Leeds, UK) and colleagues say that “incorporation of early MRI measurement in RA clinical trials will likely enable prediction of later response to treatment, allowing more rapid assessment of the efficacy of new medications.”

Their findings are based on a post-hoc analysis of pooled data from a 1-year exploratory phase II study in which 109 patients with a mean RA duration of 0.7 years were randomly assigned to receive tofacitinib or methotrexate as monotherapy, or in combination with each other.

During the study, patients were assessed for synovitis, osteitis, and erosions at the wrist and metacarpophalangeal joints using the semi-quantitative Outcome Measures in Rheumatology RA MRI scoring system (RAMRIS) and the automated quantitative RA MRI assessment system (RAMRIQ) at baseline and at 1, 3, 6, and 12 months after starting treatment.

Multivariate analysis revealed that the change in RAMRIS erosion score from baseline to 1 month was a significant independent predictor of total radiographic progression at 12 months, while changes in the RAMRIS erosion score at both 1 and 3 months significantly predicted radiographic erosion progression at 12 months.

In addition, changes in RAMRIQ osteitis at 1 and 3 months significantly predicted total and joint space narrowing radiographic progression at 12 months, while the change in RAMRIQ synovitis at 1 month significantly predicted radiographic erosion progression at 12 months.

By contrast, early changes in CDAI and DAS28-ESR were not significantly associated with radiographic progression at 12 months.

“Thus, the analyses presented here demonstrated that MRI assessment of structural changes during the first 3 months of treatment for RA, and even as early as 1 month, may better predict patients’ radiographically assessed response to treatment by month 12 than changes in clinical measures of disease activity in those 3 months,” Conaghan and co-authors write in Arthritis Research & Therapy.

They suggest that MRI could potentially be used “as a biomarker to inform treatment decisions in clinical practice” but caution that the “analyses were exploratory in nature with the intent to determine which parameters had the strongest ability to predict treatment response” and therefore need further validation before any firm conclusions can be drawn.

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Arthritis Res Ther 2019; doi: 10.1186/s13075-019-2000-1