MRI病变能否预测已获临床缓解的早期RA未来放射学进展

MRI病变能否预测已获临床缓解的早期RA未来放射学进展

Tamai M, et al. EULAR 2015. Present ID: FRI0048.

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FRI0048 MRI BONE EROSION AT BASELINE PREDICTS THE SUBSEQUENT RADIOGRAPHIC PROGRESSION IN EARLY-STAGE RA PATIENTS WHO ACHIEVED IN SUSTAINED CLINICAL GOOD RESPONSE: SUB-ANALYSIS FROM NAGASAKI UNIVERSITY EARLY ARTHRITIS COHORT M. Tamai1,*, K. Arima2, Y. Nakashima1, J. Kita1, M. Umeda1, S. Fukui1, A. Nishino1, T. Suzuki1, Y. Horai1, A. Okada3, T. Koga1, S.-Y. Kawashiri2, N. Iwamoto1, K. Ichinose1, S. Yamasaki4, H. Nakamura1, T. Origuchi5, K. Aoyagi2, M. Uetani6, K. Eguchi7, A. Kawakami1 1Immunology and Rheumatology, 2Department of Public Health, Nagasaki University, 3Rheumatology, Red Cross Nagasaki Genbaku Hospital, Nagasaki, 4Department of Clinical Immunology and Rheumatology, HIroshima University, HIroshima, 5Department of Locomotive Rehabilitation Sciences, 6Department of Radiological Sciences, Nagasaki University, Nagasaki, 7Rheumatology, 6Sasebo City General Hospital, Sasebo, Japan Background: An international task force toward T2T suggests that drug therapy should be adjusted every 3 months until the desired treatment target is reached. EULAR recommendations for the use of imaging of joints in the clinical management of RA state that MRI is useful in monitoring disease activity. However, there are few clinical investigations searching whether MRI findings are even helpful to consider radiographic progression in RA patients achieved in sustained clinical good response. Objectives: To examine whether baseline MRI findings are useful to predict subsequent radiographic progression in early-stage RA patients who achieved in sustained clinical good response through T2T therapeutic strategy. Methods:  This is a sub-analysis from the 1-year observational study from 76 early-stage RA patients recruited consecutively from Nagasaki University Early Arthritis Cohort in which subjects received Gd-enhanced MRI of both wrists and finger joints every 6 months. All patients had been received DMARDs during 1 year after entry and we have selected the 36 patients in which the favorable clinical response was obtained. The favorable clinical response was defined by decrement of DAS28 ≧1.2 at 3 months as well as achievement of DAS28 low disease activity or remission at 6 months to 1 year. Synovitis, bone edema and bone erosion determined by Gd-enhanced MRI were scored by OMERACT-RAMRIS. Plain radiographic damages were scored by Genant-modified Sharp score. We have investigated whether baseline MRI findings are helpful to predict subsequent radiographic progression in these 36 good clinical responders. Results: Median age, disease duration were 55 y.o, 2.4 months and median DAS28-CRP, CRP (mg/dl), MMP-3 (ng/ml) were 4.4, 0.90 and 82.1, respectively. Rate of ACPA-positive and RF-positive were both 80%. Median RAMRIS synovitis, bone edema, bone erosion score and Genant-modified Sharp score at baseline were 8, 1.5, 0 and 0, respectively. Among the 36 good clinical responders, ten patients developed radiographic progression at 1 year (Δscore > 0). Multivariate logistic regression analysis has identified that baseline RAMRIS bone erosion score (1 increase, Odds ratio 3.29, 95% C.I. 1.36-7.95) is the only independent predictor toward the development of plain radiographic progression at 1 year. In addition, cut-off point 1.5 of baseline MRI bone erosion score showed the best discriminative value toward plain radiographic progression (sensitivity 80.0%, specificity 84.6%). Conclusions: Our present data suggest that MRI bone erosion involves in poor radiographic outcome in patients with early-stage RA even successfully treated by T2T strategy. Physicians should pay attention to the presence of MRI bone erosion in these patients. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2015-eular.5527

背景：一个制订目标治疗策略的国际特别工作组建议RA药物治疗应每3个月调整一次直至达到想要的目标。 有关将关节成像应用于RA临床管理的EULAR建议称MRI有助于监测疾病活动性。然而, 很少有临床研究探讨MRI病变对于临床上持续良好应答的患者而言是否有助于预测放射学进展。 目的: 探究基线MRI病变是否能用于预测已通过T2T策略获得持久良好临床应答的早期RA患者的放射学进展。 方法: 本研究是一项针对76例早期RA为期一年观察的亚组分析。患者来自长崎大学早期关节炎队列, 应用钆增强MRI检查受试者的双侧手腕和双手手指关节, 每6个月一次。入组后所有患者已接受DMARDs治疗1年, 我们从中选择已获良好临床反应的36例患者。良好临床反应定义为治疗3个月时DAS28自基线改善≥1.2, 且在6~12个月内达到DAS28低疾病活动度或临床缓解。按照OMERACT-RAMRIS评估标准对钆增强MRI发现的滑膜炎、骨髓水肿及骨侵蚀进行评分。按照Genant改良的Sharp评估方法对放射学损伤进行评分。分析基线MRI所发现病是否有助于预测这36例良好临床应答患者的影像学进展。 结果: 平均年龄55岁, 病程2.4个月, DAS28-CRP均值3.3, CRP(mg/dL)均值为0.90, MMP-3均值(ng/mL)为82.1。ACPA和RF阳性率均为80％。RAMRIS滑膜炎、骨水肿、骨侵蚀得分中位数分别为8、1.5和0, Genant改良Sharp评分中位数为0。36例良好临床应答患者中有10例在随访1年时出现放射学进展(放射学评分自基线加重>0)。多变量逻辑回归分析确定了随访1年时放射学进展的唯一独立预测因子, 即基线RAMRIS骨侵蚀评分(如果增加1分, 比值比为3.29, 95％CI: 1.36 - 7.95)。此外, 基线MRI骨侵蚀评分的界值1.5对于未来放射学进展有最佳区分价值(敏感性80.0％, 特异性为84.6％)。 结论: 我们目前的数据表明, 即便是通过T2T策略成功获得病情控制的患者, MRI骨侵蚀预示这些患者放射学结果不会好。医生应注意这些患者所存在的MRI骨侵蚀。