Early magnetic resonance imaging (MRI) measurement may better predict long-term structural progression in patients with rheumatoid arthritis (RA), according to research published in Arthritis Research & Therapy.

Researchers conducted a post hoc analysis of randomized trial data from 109 patients with early RA who had never taken methotrexate. Overall, data were combined across 3 treatment arms: methotrexate monotherapy, tofacitinib monotherapy, and tofacitinib plus methotrexate. The team evaluated erosions, synovitis, and osteitis using the automated quantitative RA MRI assessment system (RAMRIQ) and RA MRI scoring system (RAMRIS) at baseline, and at 1-, 3-, 6-, and 12-month follow-up. Statistical analyses were conducted to evaluate whether early MRI responses could predict later radiographic disease progression.

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After analysis, the researchers found that changes in RAMRIQ osteitis and synovitis, as well as in RAMRIS erosions at 1- and 3-month follow-up significantly predicted radiographic progression and RAMRIS erosions at 12 months (All P <.01).


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In the multivariate analysis, RAMRIQ osteitis and RAMRIS erosion changes at 1 and 3 months and at 1-month follow-up, respectively, independently predicted radiographic progression at 12 months (both P <.01).

One key limitation of the study was the small sample size.

“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,” the researchers wrote.

“There is also the potential to use MRI as a biomarker to inform treatment decisions in clinical practice,” they added.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Conaghan PG, Østergaard M, Troum O, et al. Very early MRI responses to therapy as a predictor of later radiographic progression in early rheumatoid arthritis. Arthritis Res Ther. 2019;21:214.