MRI Scoring System Can Predict Treatment Response in Rheumatoid Arthritis

Rheumatoid arthritis in a wrist
Rheumatoid arthritis in a wrist
Researchers examined an MRI scoring system in combination with serum biomarkers to predict treatment response to methotrexate in treatment-naïve patients with RA.

In patients with rheumatoid arthritis (RA), using the RA magnetic resonance imaging (RA-MRI) scoring system (RAMRIS) at baseline can predict treatment response, according to findings published online in the Journal of Rheumatology.

In addition, the results indicated that RAMRIS synovitis subscore at the second metacarpophalangeal (MCP) joint and receptor activator of nuclear factor-kB ligand (RANKL) are associated with treatment response and remission, respectively.

The study included 28 participants with RA who were prospectively assessed with baseline 3-T MRI of the clinical dominant hand 3 and 6 months after methotrexate treatment. All participants met the 2010 American College of Rheumatology/European League Against Rheumatism (EULAR) criteria (average age 56.8 [range 39 to 74]; positive for rheumatoid factor and/or anticyclic citrullinated peptide antibodies; disease duration <6 months [range 2to 23 weeks]). 

The researchers obtained RAMRIS and serum biomarkers consisting of various experimental proteins including RANKL. Remission or treatment response was defined according to EULAR.

At 3 months, treatment response was associated with low RAMRIS erosion subscores (P =.019) and low total RAMRIS scores (P =.03). Remission at 6 months was associated with low RANKL levels (P =.033).

In multivariate analyses, treatment response at 3 and 6 months was predicted more accurately with the inclusion of total RAMRIS score, RAMRIS synovitis subscore at the MCP joint, or a combination of the two (P value likelihood ratio test = .035, .035, and .041, respectively). Remission was more accurately predicted with the inclusion of RANKL, with no significant predictive effect of MRI.

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“Our data suggest that MRI and biomarkers may aid response prediction and facilitate patient selection for intensified therapy in the future,” the researchers wrote.

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Sewerin P, Le L, Vordenbaumen S, et al. Rheumatoid arthritis magnetic resonance imaging score predicts therapy response: results of the German ArthoMark cohort [published April 1, 2018]. J Rheumatol. doi:10.3899/jrheum.170797