Friday, 8 August 2014

MRI May be Helpful in Predicting Rheumatoid Arthritis Disease Activity

The more you and your doctor know about your RA, the better you can manage it. Doctors regularly monitor RA patient disease activity, which is the term used to refer to ongoing inflammation, symptoms, and/or joint damage in order to better manage the condition.  Information about the level of disease activity allows doctors to monitor an individual’s response to treatment and to adjust treatment as needed.

Commonly used measures of disease activity are the DAS28 (Disease Activity Score with 28 joint counts), and the Vectra DA test, which is an innovative blood test that allows doctors to test for several biological markers (or biomarkers) of RA simultaneously. Now the results of a clinical study in Europe suggest that MRI may also be a useful adjunct to monitor RA disease activity.

Physicians at the Leiden Early Arthritis Clinic have previously demonstrated that inflammation could be detected with MRI in joints without any apparent clinical inflammation in patients with early arthritis, but whether these non-swollen inflamed joints would show radiographic damage had not been explored.(1)

In the current study the doctors obtained MRIs of wrists and metacarpophalangeal and metatarsophalangeal joints in 179 patients and then took radiographs of the same joints after a year.(2) They found that arthritic joints that showed no clinical inflammation (swelling) but had evidence of subclinical inflammation on MRI had more than three times the risk of radiographic progression by 1 year.  When compared with joints having no detectable inflammation, non-swollen joints with any signs of inflammation on MRI were more likely to have evidence of joint damage as measured by radiographic progression.  The cumulative amount of MRI inflammation in non-swollen joints was comparable with that in swollen joint.

The study findings suggest that MRI could be useful for identifying joints that may show early damage even before clinical inflammation is apparent. The DAS28 score and Vectra DA test are established, fairly cost effective ways of assessing and measuring disease activity in patients with RA. It appears that MRI may also play a useful role in measuring disease activity to help doctors and patients arrive at good therapeutic choices in the overall management of RA.


Krabben A1, Stomp W, Huizinga TW, van der Heijde D, et al. Concordance between inflammation at physical examination and on MRI in patients with early arthritis. Ann Rheum Dis. 2013 Dec 12. [Epub ahead of print]
Krabben A, Stomp W, van Nies JAB, et al. MRI-detected subclinical joint inflammation is associated with radiographic progression. Ann Rheum Dis. doi:10.1136/annrheumdis-2014-205208


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