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BERLIN – Treated patients in remission from rheumatoid arthritis who are rheumatoid factor–positive and have a high level of joint synovitis visible on MRI have an increased risk for progressive joint damage, according to a review of 287 patients from six international registry cohorts.
The presence of joint synovitis during remission signaled an especially poor prognosis in rheumatoid factor (RF)-positive patients, who accounted for slightly more than half of the group studied. Among rheumatoid arthritis (RA) patients in remission who were RF-positive and had an RA MRI score (RAMRIS) of 6 or more, 42% subsequently had progressive joint erosions, Dr. Espen A. Haavardsholm said at the annual European Congress of Rheumatology.
In contrast, among RF-positive patients in remission with a RAMRIS of 5 or less, 12% had radiographic progression. Among all RF-negative patients, the rate of radiographic progression was less than 20% regardless of their RAMRIS.
What this means is that when RA patients are in remission on treatment, if they are RF-negative their risk of radiographic progression is low and MRI examinations aren’t needed. But if they are RF-positive and if they score 6 or more for synovitis on MRI, their risk for progression is high, and they need close monitoring and no change in their treatment. Patients with a score of 5 or less, as well as those who are RF-negative, are candidates for less rigorous follow-up and a possible step-down in their treatment, said Dr. Haavardsholm, a rheumatologist at Diakohnjemmet Hospital in Oslo.
"When patients are in remission, do you keep them on their current treatment or step down? We suggest you take an MRI and decide based on that," he said in an interview. Although ideally a prospective study should be done to test this approach, "I would manage patients this way right now," Dr. Haavardsholm said. "If a patient [in remission] is RF-positive, they are a good candidate for MRI; that’s the implication of our study."
Dr. Haavardsholm and his associates from the OMERACT (Outcome Measures in Rheumatology) MRI in RA Task Force used data collected on 287 RA patients in remission or with low disease activity on treatment who were in registries in Oslo; Paris; Sydney; Leeds, England; and two different cohorts in Copenhagen. The patients ranged from 43 to 63 years old, and their average RA duration was about 2 years. Virtually all patients were on treatment with a disease-modifying antirheumatic drug, 15% were also on treatment with a biologic agent, and a quarter were on an oral corticosteroid. Nearly three-quarters were in remission, with the rest having low disease activity. The researchers had baseline MRI results for all patients.
A multivariate stepwise regression analysis and calculation of a receiver-operator curve for various cutoffs of the RAMRIS for synovitis showed that best dichotomous separation occurred when a RAMRIS of 0-5 was considered low and a score of 6 or more was considered high. Using this cutoff, the researchers found that among RF-positive patients, those with a score of at least 6 had a 4.4-fold increased risk for progressive joint disease compared with patients with a baseline score of 5 or less, a statistically significant difference, Dr. Haavardsholm reported. Among patients who were RF-negative, a RAMRIS of 6 or more boosted the risk for joint progression by 9% compared with patients with a score of 5 or less, a difference that was not statistically significant.
Dr. Haavardsholm said that he had no disclosures.
BERLIN – Treated patients in remission from rheumatoid arthritis who are rheumatoid factor–positive and have a high level of joint synovitis visible on MRI have an increased risk for progressive joint damage, according to a review of 287 patients from six international registry cohorts.
The presence of joint synovitis during remission signaled an especially poor prognosis in rheumatoid factor (RF)-positive patients, who accounted for slightly more than half of the group studied. Among rheumatoid arthritis (RA) patients in remission who were RF-positive and had an RA MRI score (RAMRIS) of 6 or more, 42% subsequently had progressive joint erosions, Dr. Espen A. Haavardsholm said at the annual European Congress of Rheumatology.
In contrast, among RF-positive patients in remission with a RAMRIS of 5 or less, 12% had radiographic progression. Among all RF-negative patients, the rate of radiographic progression was less than 20% regardless of their RAMRIS.
What this means is that when RA patients are in remission on treatment, if they are RF-negative their risk of radiographic progression is low and MRI examinations aren’t needed. But if they are RF-positive and if they score 6 or more for synovitis on MRI, their risk for progression is high, and they need close monitoring and no change in their treatment. Patients with a score of 5 or less, as well as those who are RF-negative, are candidates for less rigorous follow-up and a possible step-down in their treatment, said Dr. Haavardsholm, a rheumatologist at Diakohnjemmet Hospital in Oslo.
"When patients are in remission, do you keep them on their current treatment or step down? We suggest you take an MRI and decide based on that," he said in an interview. Although ideally a prospective study should be done to test this approach, "I would manage patients this way right now," Dr. Haavardsholm said. "If a patient [in remission] is RF-positive, they are a good candidate for MRI; that’s the implication of our study."
Dr. Haavardsholm and his associates from the OMERACT (Outcome Measures in Rheumatology) MRI in RA Task Force used data collected on 287 RA patients in remission or with low disease activity on treatment who were in registries in Oslo; Paris; Sydney; Leeds, England; and two different cohorts in Copenhagen. The patients ranged from 43 to 63 years old, and their average RA duration was about 2 years. Virtually all patients were on treatment with a disease-modifying antirheumatic drug, 15% were also on treatment with a biologic agent, and a quarter were on an oral corticosteroid. Nearly three-quarters were in remission, with the rest having low disease activity. The researchers had baseline MRI results for all patients.
A multivariate stepwise regression analysis and calculation of a receiver-operator curve for various cutoffs of the RAMRIS for synovitis showed that best dichotomous separation occurred when a RAMRIS of 0-5 was considered low and a score of 6 or more was considered high. Using this cutoff, the researchers found that among RF-positive patients, those with a score of at least 6 had a 4.4-fold increased risk for progressive joint disease compared with patients with a baseline score of 5 or less, a statistically significant difference, Dr. Haavardsholm reported. Among patients who were RF-negative, a RAMRIS of 6 or more boosted the risk for joint progression by 9% compared with patients with a score of 5 or less, a difference that was not statistically significant.
Dr. Haavardsholm said that he had no disclosures.
BERLIN – Treated patients in remission from rheumatoid arthritis who are rheumatoid factor–positive and have a high level of joint synovitis visible on MRI have an increased risk for progressive joint damage, according to a review of 287 patients from six international registry cohorts.
The presence of joint synovitis during remission signaled an especially poor prognosis in rheumatoid factor (RF)-positive patients, who accounted for slightly more than half of the group studied. Among rheumatoid arthritis (RA) patients in remission who were RF-positive and had an RA MRI score (RAMRIS) of 6 or more, 42% subsequently had progressive joint erosions, Dr. Espen A. Haavardsholm said at the annual European Congress of Rheumatology.
In contrast, among RF-positive patients in remission with a RAMRIS of 5 or less, 12% had radiographic progression. Among all RF-negative patients, the rate of radiographic progression was less than 20% regardless of their RAMRIS.
What this means is that when RA patients are in remission on treatment, if they are RF-negative their risk of radiographic progression is low and MRI examinations aren’t needed. But if they are RF-positive and if they score 6 or more for synovitis on MRI, their risk for progression is high, and they need close monitoring and no change in their treatment. Patients with a score of 5 or less, as well as those who are RF-negative, are candidates for less rigorous follow-up and a possible step-down in their treatment, said Dr. Haavardsholm, a rheumatologist at Diakohnjemmet Hospital in Oslo.
"When patients are in remission, do you keep them on their current treatment or step down? We suggest you take an MRI and decide based on that," he said in an interview. Although ideally a prospective study should be done to test this approach, "I would manage patients this way right now," Dr. Haavardsholm said. "If a patient [in remission] is RF-positive, they are a good candidate for MRI; that’s the implication of our study."
Dr. Haavardsholm and his associates from the OMERACT (Outcome Measures in Rheumatology) MRI in RA Task Force used data collected on 287 RA patients in remission or with low disease activity on treatment who were in registries in Oslo; Paris; Sydney; Leeds, England; and two different cohorts in Copenhagen. The patients ranged from 43 to 63 years old, and their average RA duration was about 2 years. Virtually all patients were on treatment with a disease-modifying antirheumatic drug, 15% were also on treatment with a biologic agent, and a quarter were on an oral corticosteroid. Nearly three-quarters were in remission, with the rest having low disease activity. The researchers had baseline MRI results for all patients.
A multivariate stepwise regression analysis and calculation of a receiver-operator curve for various cutoffs of the RAMRIS for synovitis showed that best dichotomous separation occurred when a RAMRIS of 0-5 was considered low and a score of 6 or more was considered high. Using this cutoff, the researchers found that among RF-positive patients, those with a score of at least 6 had a 4.4-fold increased risk for progressive joint disease compared with patients with a baseline score of 5 or less, a statistically significant difference, Dr. Haavardsholm reported. Among patients who were RF-negative, a RAMRIS of 6 or more boosted the risk for joint progression by 9% compared with patients with a score of 5 or less, a difference that was not statistically significant.
Dr. Haavardsholm said that he had no disclosures.
AT THE ANNUAL EUROPEAN CONGRESS OF RHEUMATOLOGY