RA: MRI Values May Not Benefit Clinical, Radiographic Outcomes in Treat-to-Target Strategy

The following article is part of conference coverage from the European League Against Rheumatism (EULAR) Congress 2018 in Amsterdam, The Netherlands. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from EULAR 2018.

Targeting absence of magnetic resonance imaging (MRI) bone marrow edema in addition to a conventional treat-to-target strategy in patients with rheumatoid arthritis (RA) in clinical remission had no effect on clinical and radiographic outcomes compared with a conventional treat-to-target strategy alone, according to data presented at the European League Against Rheumatism (EULAR) Congress held in Amsterdam, June 13 to 16, 2018.

Investigators conducted the 2-year, randomized, open-label IMAGINE-RA study (ClinicalTrials.gov identifier: NCT01656278) to determine whether a treat-to-target strategy based on structured MRI assessments targeting absence of osteitis or bone marrow edema would lead to improved clinical and radiographic outcomes compared with a conventional treat-to-target strategy. The study included 200 patients with RA in clinical remission, defined as Disease Activity Score assessing 28 joints (DAS28-CRP) <3.2 and no swollen joints, who were receiving conventional synthetic disease-modifying antirheumatic drugs.

Participants were randomly assigned to undergo a conventional DAS28-CRP-guided treat-to-target strategy, targeting DAS28-CRP <3.2 and no swollen joints, or an MRI-guided treat-to-target strategy, which included the same clinical treat-to-target strategy, in addition to MRI targeting absence of bone marrow edema. Participants were followed every 4 months during a 2-year follow-up period. The primary endpoints were the proportion of patients achieving DAS28-CRP remission (DAS28-CRP<2.6) and the proportion of patients with no radiographic progression (change in total Sharp/vdHeijde score ≤0).

A total of 76 patients in the MRI treat-to-target group and 95 patients in the conventional treat-to-target group completed the study. Of these, 85% of participants in the MRI treat-to-target group and 88% of participants in the conventional treat-to-target group achieved DAS28-CRP remission (P =.569). In addition, 66% of participants in the MRI treat-to-target group and 62% in the conventional treat-to-target group had no radiographic progression (P =.606).

The researchers also found that American College of Rheumatology/EULAR remission rates, swollen joint counts, patient visual analogue global scores, and Healthcare Access and Quality Index scores favored the MRI treat-to-target group (P =.038).

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Reference

Møller-Bisgaard S, Hørslev-Pedersen K, Ejbjerg, et al. The value of adding MRI to a clinical treat-to-target strategy in rheumatoid arthritis patients in clinical remission: clinical and radiographic outcomes from the IMAGINE-RA randomized controlled trial. Presented at: European League Against Rheumatism (EULAR) Congress 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract OP0018.