OP0042 In acpa positive at-risk individuals, which mri and us findings best predict development of clinical synovitis?

Abstract

BackgroundACPA +individuals with non-specific MSK symptoms are at risk of inflammatory arthritis (IA) and may benefit from early intervention. Clinical, serological and US markers have previously been assessed to determine risk of progression.1 ObjectivesEvaluate the value of MR and US imaging in characterising and quantifying risk in a large ACPA +cohort.MethodsEligible ACPA +individuals without clinical synovitis had gadolinium enhanced 3.0 T MRI of the dominant hand and wrist. Images were scored by 2 radiologists for synovitis, bone marrow oedema (BME), erosions and tenosynovitis (TSV) according to OMERACT RAMRIS. Joint counts for each abnormality at each joint were corrected for age using a healthy controls reference range.2 US of the same regions were scored using OMERACT definitions. Maximum MRI and US abnormality scores observed per patient across all joints scored were dichotomised <2,≥2. Potential associations between baseline US (greyscale (GS) and powerDoppler (PD)) and MRI findings and i) progression to IA and ii) development of clinical synovitis within a joint were identified using Cox and penalised regression.ResultsImaging of 98 individuals (mean age 47, 69% female) was available. 30% (29/98) progressed to IA. Median time to progression was 31 weeks (IQR 24, 67). BME and erosions scores≥2 were reported in 10%, preferential location to the carpal bones/wrist joints. Synovitis score ≥2 was present in 9%, preferential location at MCP5 and radial carpal/intercarpal joints. TSV was the most frequent reported abnormality with 22% scoring ≥2, 40% scoring 1. US GS and PD scores≥2 were reported in 23% and 9% respectively. The unadjusted analysis HRs for all imaging abnormalities were high, indicating potential association with risk of progression. Controlling for variables, MRI TSV was associated with time to IA with an increased HR. US GS and PD were also independently associated with time to progression and confirmed on penalised regression, table 1. At the joint level MRI TSV, BME and US GS were associated with the risk of progression to clinical synovitis, HR=7.03 p<0.001, HR 4.22 p=0.076 and HR 8.04 p<0.001 respectively.Abstract OP0042 – Table 1Patient-level Cox regression proportional hazard modelling of associations between maximum observed score per patient for baseline MRI abnormalities and time to IA (n=95)AbnormalityNo IA% (n=66)IA% (n=29)Unadjusted HR (90% CI),P valueAdjusted HR (90% CI),P valuePenalised HR Small joint tenderness44(29)55(16)1.60 (0.87,2.97), p=0.2071.20 (0.58,2.46), p=0.6791RF and/or ACPA>3ULN83(55)93(27)2.14 (0.64,7.16), p=0.3011.02 (0.27,3.80), p=0.9811EMS≥30 min27(18)45(13)2.00 (1.08,3.71), p=0.0641.52 (0.69,3.37), p=0.3841US PD≥22 (1)28(8)7.21 (3.62,14.36), p<0.0015.09 (1.93,13.44), p=0.0064.37US GS≥211(7)52(15)4.97 (2.69,9.19), p<0.0012.69 (1.14,6.34), p=0.0592.17MRI erosion≥26 (4)17(5)2.15 (0.96,4.82), p=0.1200.59 (0.20,1.76), p=0.4311MRI BME≥28 (5)17(5)2.30 (1.01,5.23), p=0.0971.55 (0.56,4.27), p=0.4821MRI synovitis≥23 (2)24(7)4.22 (2.03,8.75), p=0.0011.08 (0.46,2.54), p=...

Long‐term outcome of patients with palindromic rheumatism treated with methotrexate

“…14,15 However, many consider PR as an at-risk phenomenon, which like other pre-RA conditions, like patients with inflammatory arthralgia, having periarthritis on magnetic resonance imaging, or ultrasound features for arthritis, was the most predictive of developing RA in the future. [16][17][18] The finding of RA-associated auto-antibodies in a large percentage of patients with PR could also be a reason for this hypothesis. 19,20 In addition, we have previously shown that PR treatment with a method like RA, that is with tight control strategy using combination of DMARDs, can prevent disease progression to chronic arthritis.…”

EULAR points to consider for conducting clinical trials and observational studies in individuals at risk of rheumatoid arthritis

“… 35 50 95 Tenosynovitis was the only MRI abnormality associated with arthritis progression at patient level in a study of 98 ACPA+ individuals with MSK symptoms (HR 4.02 (1.91–8.44), p=0.002). 95 Similarly, tenosynovitis was the only MRI risk factor independently associated with arthritis development in a prospective study of 150 patients with CSA (HR 8.39 (3.38–20.81), p<0.001). There is also an increased prevalence of hand interosseous tendon inflammation in ACPA+ individuals with MSK symptoms.…”

A core set of risk factors in individuals at risk of rheumatoid arthritis: a systematic literature review informing the EULAR points to consider for conducting clinical trials and observational studies in individuals at risk of rheumatoid arthritis

“…41 GS synovitis in the wrists and MCP joints and PD signal in the MTP joints were all associated with development of RA in a UK cohort of patients with very early UA. 42 In a subsequent analysis of 107 patients with UA by In both ACPA-positive individuals with MSK symptoms and patients with CSA, subclinical inflammation on MRI has been associated with arthritis development [44][45][46] (table 4). In both populations, MRI tenosynovitis was the most prevalent MRI abnormality and also the most strongly associated with arthritis development.…”

“…46 Similarly, at patient level, MRI tenosynovitis was the only MRI feature associated with arthritis development in a UK cohort of 98 ACPA-positive individuals with MSK symptoms (HR 4.02, 95% CI 1.9 to 8.4, p<0.01). 45 MRI findings in patients with UA are also associated with disease progression and specifically RA development. 47 48 In a small study of patients with recent-onset polyarthritis, MRI tenosynovitis of the finger flexor tendons and extensor carpi ulnaris, and synovitis of the radioulnar joint were associated with progression to RA.…”