Signe Møller-Bisgaard1,2, Stylianos Georgiadis1, Kim Hørslev-Petersen3,4, Bo Ejbjerg2, Merete Lund Hetland1,5, Lykke Midtbøll Ørnbjerg1, Daniel Glinatsi1,6, Jakob Møller7, Mikael Boesen8, Kristian Stengaard-Pedersen9,10, Ole Rintek Madsen11, Bente Jensen12, Jan Alexander Villadsen13, Ellen-Margrethe Hauge9,10, Philip Bennett11, Oliver Hendricks3, Karsten Asmussen12, Marcin Kowalski14, Hanne Lindegaard15, Henning Bliddal16, Niels Steen Krogh17, Torkell Ellingsen15, Agnete H Nielsen18, Lone Balding7, Anne Grethe Jurik19, Henrik S Thomsen7, Mikkel Østergaard1,5. 1. Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark. 2. Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark. 3. Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark. 4. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. 5. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 6. Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden. 7. Department of Radiology, Herlev and Gentofte University Hospital, Herlev, Denmark. 8. Department of Radiology, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark. 9. Department of Rheumatology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark. 10. Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark. 11. Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark. 12. Department of Rheumatology, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark. 13. Department of Rheumatology, Silkeborg Hospital, Silkeborg, Denmark. 14. Department of Rheumatology, Hjørring Hospital, Hjørring, Denmark. 15. Rheumatology Research Unit, Odense University Hospital, Odense, Denmark. 16. Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. 17. ZiteLab Aps, Copenhagen, Denmark. 18. Department of Radiology, Silkeborg Hospital, Silkeborg, Denmark. 19. Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
Abstract
OBJECTIVES: To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy. METHODS:RA patients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs were randomized to conventional or MRI-targeted treat-to-target strategies with predefined algorithmic treatment escalations. Potentially predictive baseline variables were tested in multivariate logistic regression analyses. RESULTS: In the 171 patients included, baseline MRI osteitis independently predicted progression in MRI erosion [odds ratio (OR) 1.13 (95% CI 1.06, 1.22)], joint space narrowing [OR 1.15 (95% CI 1.07, 1.24)] and combined damage [OR 1.23 (95% CI 1.13, 1.37)], while tenosynovitis independently predicted MRI erosion progression [OR 1.13 (95% CI 1.03, 1.25)]. A predictor of radiographic erosion progression was age, while gender predicted progression in joint space narrowing. Following an MRI treat-to-target strategy predicted stringent remission across all remission definitions: Clinical Disease Activity Index remission OR 2.94 (95% CI 1.25, 7.52), Simplified Disease Activity Index remission OR 2.50 (95% CI 1.01, 6.66), ACR/EULAR Boolean remission OR 5.47 (95% CI 2.33, 14.13). Similarly, low tender joint count and low patient visual analogue scale pain and global independently predicted achievement of more stringent remission. CONCLUSION:Baseline MRI osteitis and tenosynovitis were independent predictors of 2 year MRI damage progression in RA patients in clinical remission, while independent predictors of radiographic damage progression were age and gender. Following an MRI treat-to-target strategy, low scores of patient-reported outcomes and low tender joint count predicted achievement of stringent remission. TRIAL REGISTRATION: ClinicalTrials.gov (https://clinicaltrials.gov), NCT01656278.
RCT Entities:
OBJECTIVES: To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy. METHODS:RApatients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs were randomized to conventional or MRI-targeted treat-to-target strategies with predefined algorithmic treatment escalations. Potentially predictive baseline variables were tested in multivariate logistic regression analyses. RESULTS: In the 171 patients included, baseline MRI osteitis independently predicted progression in MRI erosion [odds ratio (OR) 1.13 (95% CI 1.06, 1.22)], joint space narrowing [OR 1.15 (95% CI 1.07, 1.24)] and combined damage [OR 1.23 (95% CI 1.13, 1.37)], while tenosynovitis independently predicted MRI erosion progression [OR 1.13 (95% CI 1.03, 1.25)]. A predictor of radiographic erosion progression was age, while gender predicted progression in joint space narrowing. Following an MRI treat-to-target strategy predicted stringent remission across all remission definitions: Clinical Disease Activity Index remission OR 2.94 (95% CI 1.25, 7.52), Simplified Disease Activity Index remission OR 2.50 (95% CI 1.01, 6.66), ACR/EULAR Boolean remission OR 5.47 (95% CI 2.33, 14.13). Similarly, low tender joint count and low patient visual analogue scale pain and global independently predicted achievement of more stringent remission. CONCLUSION: Baseline MRI osteitis and tenosynovitis were independent predictors of 2 year MRI damage progression in RApatients in clinical remission, while independent predictors of radiographic damage progression were age and gender. Following an MRI treat-to-target strategy, low scores of patient-reported outcomes and low tender joint count predicted achievement of stringent remission. TRIAL REGISTRATION: ClinicalTrials.gov (https://clinicaltrials.gov), NCT01656278.
Authors: Ulf Sundin; Nina Paulshus Sundlisater; Anna-Birgitte Aga; Joseph Sexton; Lena Bugge Nordberg; Hilde Berner Hammer; Desirée van der Heijde; Tore K Kvien; Espen A Haavardsholm; Siri Lillegraven Journal: RMD Open Date: 2021-02
Authors: Harris A Ahmad; Joshua F Baker; Philip G Conaghan; Paul Emery; Thomas W J Huizinga; Yedid Elbez; Subhashis Banerjee; Mikkel Østergaard Journal: Arthritis Res Ther Date: 2022-02-16 Impact factor: 5.156