Wrist MRI Indicates Prognosis in Early Rheumatoid Arthritis

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Wrist MRI Indicates Prognosis in Early Rheumatoid Arthritis

Ann Rheum Dis. 2004;63:473-477, 555-561

http://www.medscape.com/

Magnetic resonance imaging (MRI) of the wrist in patients with early

rheumatoid arthritis may predict functional outcome six years later,

according to the results of a study published in the May issue of the

ls of Rheumatic Diseases. The authors and editorialist suggest that

this may help with targeting patients for aggressive management.

" The ability to predict accurately prognosis at presentation in patients

with rheumatoid arthritis is becoming an increasingly important part of

clinical management, " write Nick Benton, BSc, MBBS, from Auckland

Hospital in New Zealand, and colleagues. " With the advent of biological

and conventional disease modifying antirheumatic drugs (DMARDs)

possessing powerful anti-erosive effects, it may be possible to greatly

reduce or even completely prevent joint damage...and reduce the risk of

an adverse functional outcome. "

Forty-two patients meeting criteria for rheumatoid arthritis when first

evaluated had dominant wrist MRIs at presentation and one year later. Of

these patients, 31 patients also had repeat MRIs at six years. Two

radiologists scored the MRIs for synovitis, tendonitis, bone edema, and

erosions. During prospective follow-up at 0, 1, 2, and 6 years, patients

were evaluated with the Stanford Health Assessment Questionnaire (HAQ)

indicating functional outcome, and with standard measures of disease

activity. At six years, investigators also calculated the physical

function component of the SF-36 score (PF-SF36).

The total baseline MRI score (R2 = .22; P = .005), bone edema score (R2

= .16; P = .02), and other baseline MRI parameters predicted the PF-SF36

at six years. Although the PF-SF36 score correlated strongly with the

HAQ score at six years (rs = ?.725; P <.0001), none of the baseline MRI

parameters predicted the six-year HAQ score. However, the total MRI

score obtained at one year predicted the six-year HAQ (R2 = .04; P = .01).

Standard clinical and radiographic measures at baseline did not predict

the six-year PF-SF36. However, when combined in a model with baseline

MRI edema score, predictive value increased from 0.09 to 0.23, or 23% of

the six-year variance.

Study limitations include DMARD treatment during the study, which may

have influenced the degree of joint damage and function at six years; no

attempt to standardize management in this observational study; and

noncompliance with DMARDs in some patients.

" MR imaging of the wrist in patients with early rheumatoid arthritis can

help to predict function at six years and could be used to plan

aggressive management at an earlier stage, " the authors write. " MR bone

oedema is the most significant predictor of function, probably because

of its combined ability to reflect joint inflammation and to predict

erosive damage. "

The Health Research Council of New Zealand, the Arthritis Foundation of

New Zealand, the Auckland Medical Research Foundation, Lotteries Health,

New Zealand, the Auckland Radiology Group, and Sanofi-Winthrop supported

this study.

In an accompanying editorial, C. G. fy, from Synarc Inc. in San

Francisco, California, notes that the use of conventional radiography

for managing patients with rheumatoid arthritis will diminish further

but that MRI offers a powerful alternative.

" It is far more sensitive than radiography for bone erosion in patients

with early rheumatoid arthritis, and can detect pre-erosive features,

such as osteitis and synovitis, along with tendonitis and potentially

other MRI features that can be used to predict which patients will go on

to severe destructive joint damage and irreversible functional

disability, " Dr. fy writes. " Being able to predict this accurately

at the time of initial presentation is crucial to effective patient

management. "