MRI Not Beneficial in Disease Activity Remission for RA

In a randomized trial published in JAMA Network, rheumatoid arthritis (RA) patients who underwent MRI did not have improved disease activity remission or radiographic progression compared to conventional treat-to-target strategy patients.

The two-year, multicenter study included 200 RA patients from nine hospitals in Denmark who were in clinical remission, defined as disease activity score in 28 joints–C-reactive protein (DAS28-CRP) <3.2 and no swollen joints. They were randomized 1:1 to either an MRI-guided or conventional treat-to-target strategy. In both groups, the goal was clinical remission, and the MRI goal had the additional goal of absence of MRI bone marrow edema.

Treat-to-target strategy guided by #MRI did not improve disease activity or reduce radiographic progression compared with a conventional treat-to-target strategy among patients with rheumatoid arthritis via @RheumAdvisor https://t.co/1L9cIjVFvX

— American College of Radiology (@RadiologyACR) February 9, 2019

MRI and Conventional Treatment Groups Show Similar Clinical and Radiographic Outcomes

Most patients (67%, n = 133) were women; mean age overall was 61.6 years. Baseline DAS28-CRP ranged from 1.7 to 2.2 with a mean 1.9, while baseline van der Heijde-modified Sharp score ranged from 7.0 to 42.5 with a mean 18. A total of 76 MRI patients and 95 conventional treatment patients completed the study.

The groups had similar primary clinical endpoint rates—85% (n = 64) in the MRI group and 88% (n = 83) in the conventional treatment group—as well as similar primary radiographic endpoints: 66% (n = 49) and 62% (n = 58), respectively. Among 10 key secondary end points, outcomes were null in eight, and two demonstrated significant benefit for the MRI group. Serious adverse events occurred in 17% (n = 17) of the MRI group and 6% (n = 6) of the conventional treatment group.

Implications for Rheumatoid Arthritis Patients

Study author Signe Møller-Bisgaard, MD, PhD, previously presented the findings of the IMAGINE-RA study at the European Congress of Rheumatology.

“Despite patients achieving a target of clinical remission, we still see erosive progression in about 20%-30%,” she said at the time. Despite evidence that synovial inflammation and bone marrow edema evidenced by MRI is an indicator of disease progression, the researchers wanted to know if patients in clinical remission would benefit from MRI remission.

The answer, ultimately, was no.

“Targeting absence of MRI bone marrow edema in addition to a conventional treat-to-target strategy in RA patients in clinical remission had no effect on the probability of achieving DAS28-CRP remission or halting radiographic progression,” Møller-Bisgaard said.

The results are a relief. Less expensive monitoring tools for rheumatoid arthritis perform well. https://t.co/WWZXnFg7m1

— Rheumatology for All (@Rheumforall) February 9, 2019

Can MRI Still Be Useful in Rheumatoid Arthritis?

The findings do not dismiss the value of MRI in RA patients, though, according to Møller-Bisgaard.

“It is important to emphasize that this study does not show that MRI is useless for all purposes in  rheumatoid arthritis,” she said in an interview with MedicalResearch.com. “MRI is still an important tool for example for diagnosis or prognostication, and the findings in our study only demonstrates that elimination of subclinical bone marrow edema is not a recommendable goal for a treat-to-target approach in patients with RA.”

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Source: JAMA Network