Synovial Perfusion Linked to Treatment Response, Cartilage Quality in RA

a synovial joint
a synovial joint
Researchers found data from dynamic contrast-enhanced magnetic resonance imaging that indicated improvement in synovial perfusion in patients with rheumatoid arthritis undergoing treatment for the first time with methotrexate.

In patients with early rheumatoid arthritis (RA), synovial perfusion is associated with remission, treatment response, and cartilage quality, according to study results published in the Journal of Rheumatology.

The study included treatment-naïve participants with RA as defined by 2016 European League Against Rheumatism (EULAR) criteria (n=28). Participants were assessed at baseline and 3 and 6 months after initiating methotrexate therapy.

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The researchers assessed synovial perfusion and cartilage quality using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in metacarpophalangeal joints. They calculated maximum contrast enhancement, maximum synovial volume, and rate of contrast enhancement after 17 seconds.

At 3 months, 17.9% of participants (n=5) met the EULAR remission criteria. At 12 months, this increased to 42.9% of participants (n=12). Any treatment response (good or moderate) was associated with lower maximum contrast enhancement (P <.05) but not with maximum synovial volume or rate of contrast enhancement.

The results indicated that synovial perfusion parameters were associated with remission (P <.05) and cartilage quality (P <.004). Having a high score in any DCE-MRI parameter was significantly associated with lower cartilage quality.

Over the course of methotrexate treatment, the results indicated that all DCE-MRI parameters improved, even in participants who did not meet remission or treatment response criteria.

“Our current study expands on this knowledge by demonstrating that DCE-MRI parameters consistently relate to remission and response as defined by the compound measures DAS28 according to EULAR definition,” the researchers wrote.


Sewerin P, Schleich C, Brinks R, et al. Synovial perfusion assessed by dynamic contrast-enhanced MRI is associated to treatment response, remission, and cartilage quality in rheumatoid arthritis [published online April 1, 2019]. J Rheumatol. doi:10.3899/jrheum.180832