Prediction of radiographic progression during a treat-to-target strategy by the sequential application of MRI-proven bone marrow edema and power-Doppler grade ≥2 articular synovitis in rheumatoid arthritis: retrospective observational study

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Background : Recently, it is well known the utility of both magnetic resonance imaging (MRI) and ultrasound (US) for rheumatoid arthritis (RA) in clinical practice. To investigate the favorable timing for monitoring of RA by MRI and US for predicting the radiographic progression during a treat-to-target (T2T) strategy. Methods : Symptomatic wrist and finger joints of 44 active RA patients (median disease duration 8.5 months), recruited in Nagasaki University Hospital from January 2010 to June 2017, were examined by MRI and US at baseline and then at 3-month (US) and 6-month intervals (MRI). The T2T strategy was used through 1 year. MRI was evaluated by RA MRI scoring (RAMRIS) and US by Outcomes Measures in Rheumatology Clinical Trial (OMERACT), respectively. Plain radiographs were assessed by the Genant-modified Sharp score for the symptomatic side. Radiographic progression was defined as an annual increase ≥0.75 at 1 year. Factors associated with radiographic progression were analyzed. The optimal use of MRI and US at each timepoint was considered. Results : Disease activity score (DAS) 28-ESR as well as inflammatory findings of MRI-proven bone marrow edema (BME) and US power-Doppler (PD) signal were reduced during treatment. A logistic regression model revealed that MRI-proven BME at baseline and 6 months and joint counts of PD grade ≥2 synovitis at 3 or 6 months are significantly associated with radiographic progression at 1 year. Conclusions : The combination of MRI and US at each timepoint may help predict radiographic progression in patients with early-stage RA during T2T strategies.