Mikkel Østergaard1,2, Charles G Peterfy3,4, Paul Bird3,4, Frédérique Gandjbakhch3,4, Daniel Glinatsi3,4, Iris Eshed3,4, Espen A Haavardsholm3,4, Siri Lillegraven3,4, Pernille Bøyesen3,4, Bo Ejbjerg3,4, Violaine Foltz3,4, Paul Emery3,4, Harry K Genant3,4, Philip G Conaghan3,4. 1. From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; Slagelse Hospital, Slagelse, Denmark; Spire Sciences Inc., Boca Raton, Florida; Medicine and Orthopedics, University of California; Synarc Inc., San Francisco, California, USA; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK. mo@dadlnet.dk. 2. M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; D. Glinatsi, MD, Research Fellow, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; P. Bøyesen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; B. Ejbjerg, MD, PhD, Consultant Rheumatologist and Senior Lecturer, Slagelse Hospital, and Department of Clinical Medicine, University of Copenhagen; V. Foltz, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, University of California, San Francisco, and Synarc Inc.; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre. mo@dadlnet.dk. 3. From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; Slagelse Hospital, Slagelse, Denmark; Spire Sciences Inc., Boca Raton, Florida; Medicine and Orthopedics, University of California; Synarc Inc., San Francisco, California, USA; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK. 4. M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; D. Glinatsi, MD, Research Fellow, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; P. Bøyesen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; B. Ejbjerg, MD, PhD, Consultant Rheumatologist and Senior Lecturer, Slagelse Hospital, and Department of Clinical Medicine, University of Copenhagen; V. Foltz, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, University of California, San Francisco, and Synarc Inc.; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre.
Abstract
OBJECTIVE: The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) scoring system (RAMRIS), evaluating bone erosion, bone marrow edema/osteitis, and synovitis, was introduced in 2002, and is now the standard method of objectively quantifying inflammation and damage by MRI in RA trials. The objective of this paper was to identify subsequent advances and based on them, to provide updated recommendations for the RAMRIS. METHODS: MRI studies relevant for RAMRIS and technical and scientific advances were analyzed by the OMERACT MRI in Arthritis Working Group, which used these data to provide updated considerations on image acquisition, RAMRIS definitions, and scoring systems for the original and new RA pathologies. Further, a research agenda was outlined. RESULTS: Since 2002, longitudinal studies and clinical trials have documented RAMRIS variables to have face, construct, and criterion validity; high reliability and sensitivity to change; and the ability to discriminate between therapies. This has enabled RAMRIS to demonstrate inhibition of structural damage progression with fewer patients and shorter followup times than has been possible with conventional radiography. Technical improvements, including higher field strengths and improved pulse sequences, allow higher image resolution and contrast-to-noise ratio. These have facilitated development and validation of scoring methods of new pathologies: joint space narrowing and tenosynovitis. These have high reproducibility and moderate sensitivity to change, and can be added to RAMRIS. Combined scores of inflammation or joint damage may increase sensitivity to change and discriminative power. However, this requires further research. CONCLUSION: Updated 2016 RAMRIS recommendations and a research agenda were developed.
OBJECTIVE: The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) scoring system (RAMRIS), evaluating bone erosion, bone marrow edema/osteitis, and synovitis, was introduced in 2002, and is now the standard method of objectively quantifying inflammation and damage by MRI in RA trials. The objective of this paper was to identify subsequent advances and based on them, to provide updated recommendations for the RAMRIS. METHODS: MRI studies relevant for RAMRIS and technical and scientific advances were analyzed by the OMERACT MRI in Arthritis Working Group, which used these data to provide updated considerations on image acquisition, RAMRIS definitions, and scoring systems for the original and new RA pathologies. Further, a research agenda was outlined. RESULTS: Since 2002, longitudinal studies and clinical trials have documented RAMRIS variables to have face, construct, and criterion validity; high reliability and sensitivity to change; and the ability to discriminate between therapies. This has enabled RAMRIS to demonstrate inhibition of structural damage progression with fewer patients and shorter followup times than has been possible with conventional radiography. Technical improvements, including higher field strengths and improved pulse sequences, allow higher image resolution and contrast-to-noise ratio. These have facilitated development and validation of scoring methods of new pathologies: joint space narrowing and tenosynovitis. These have high reproducibility and moderate sensitivity to change, and can be added to RAMRIS. Combined scores of inflammation or joint damage may increase sensitivity to change and discriminative power. However, this requires further research. CONCLUSION: Updated 2016 RAMRIS recommendations and a research agenda were developed.
Entities:
Keywords:
MAGNETIC RESONANCE IMAGING; OMERACT; OUTCOME ASSESSMENT; RHEUMATOID ARTHRITIS
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