Radiological quantitative measures were more sensitive than semiquantitative grading when evaluating structural and inflammatory changes in rheumatoid arthritis (RA), and were associated with patient clinical and functional outcomes, according to results of an observational, longitudinal cohort study published in The Journal of Rheumatology.

Researchers sought to explore the relationship between changes in radiologic quantitative assessment and changes in clinical and functional assessment from baseline to 3 months in patients with RA. A total of 28 patients with RA were divided into 2 treatment groups according to 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR): (1) 10 patients with a DAS28-ESR score ≤3.2 who continued on methotrexate (MTX) therapy (MTX group) and (2) 18 patients with a DAS28-ESR score ≥3.2 who initiated treatment with certolizumab pegol along with their MTX regimen (anti-TNF-α group).

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At baseline and 3 months, all patients underwent clinical (DAS28), functional (Health Assessment Questionnaire [HAQ] and Michigan Hand Outcome Questionnaire [MHQ]), and structural (imaging of the dominant hand/wrist via 3T MRI and HR-pQCT) evaluations. The MRI images were assessed semiquantitatively (RA MRI scoring [RAMRIS]), as well as quantitatively, for the volume of synovitis and bone marrow edema (BME) lesions. HR-pQCT was used to measure erosion volumes.

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After 3 months of therapy, the anti-TNF-α group showed an improvement in disease activity based on DAS28, HAQ, and MHQ (P <.001 for all). Moreover, significant decreases in synovitis and BME volume were reported in the anti-TNF-α group in contrast to significant increases in the MTX group. Furthermore, per HR-pQCT, significant decreases in bone erosion volume were detected in the anti-TNF-α group, as opposed to significant increases in the MTX group. There was no significant difference  observed with the use of RAMRIS. Changes in BME lesions, synovitis, and erosion volumes, but not RAMRIS, were significantly associated with changes in DAS28, HAQ, and MHQ.

The investigators concluded that the results of this analysis demonstrated that quantitative assessment appears to be more sensitive than semi-quantitative grading for the detection of subtle, short-term changes in patients with RA. A multimodality approach using MRI and HR-pQCT may be sufficiently powerful for evaluating early changes following treatment in patients with RA.


Shimizu T, Cruz A, Tanaka M, et al. Structural changes over a short period are associated with functional assessments in rheumatoid arthritis [published online February 15, 2019]. J Rheumatol. doi:10.3899/jrheum.180496