Advantages of a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and feet: does the RAMRIS of the hand alone underestimate disease activity and progression?

Philipp Sewerin,Falk Miese,Matthias Schneider,Christian Buchbender,Sabine Klein,Stefan Vordenbäumen,Benedikt Ostendorf,Hans-Joerg Wittsack,Axel Scherer,Gerald Antoch,Ralph Brinks

doi:10.1186/1471-2474-15-104

Abstract

BackgroundTo evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA).MethodsMagnetic resonance imaging (MRI, 0.2 Tesla) of the dominant hand and foot of 26 ACPA positive RA patients before and 6 months after initiation of methotrexate was obtained. RAMRIS of the hand was complemented by corresponding scoring of the foot (MTP I-V; HaF-score). Disease Activity Score 28 (DAS28) and a tender and swollen joint count (JC) of the joints scored in MRI were recorded. Changes in these scores (Δ) were assessed.ResultsΔHaF-score correlated significantly with ΔDAS28 (r = 0.820, 95%-CI 0.633-0.916). Correlations to ΔDAS28 were best for changes in the synovitis subscore (0.648) and bone marrow edema (0.703). Correlations to ΔDAS28 were significantly better for of the ΔHaF-score than ΔRAMRIS (0.499, 0.139-0.743, p = 0.0368).All patients with at least moderate response (EULAR criteria, n = 11) had continuing disease activity on MRI, including five cases with new erosions, three of them at the feet. Improvements of the hand JC or foot JC were seen in 16 and 15 cases, respectively. However, MRI of the hand or feet improved in only 10 and 9 cases, respectively. No patient fulfilled SDAI remission criteria.ConclusionsThe HaF-score identifies patients with continuing disease activity despite clinical response that would have been missed by consideration of the traditional RAMRIS or the DAS28 alone. Response as opposed to remission may be an insufficient goal in RA as all patients showed continuing disease activity, especially at the feet.

Highlights

To evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA)
Smolen et al demonstrated that the simplified disease activity index (SDAI), which is based on the same 28 joints used for calculation of the disease activity score 28 (DAS28), has the highest predictive value for the development of new erosions [6]
The mean value of DAS28 decreased from T0 to T1 from 3.45 to 2.9, the mean C-reactive protein levels (CRP) decreased from 0.91 mg/dl to 0.59 mg/dl

Summary

Introduction

To evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA). Rheumatoid Arthritis (RA) is a systemic inflammatory disease causing bone destruction and functional impairment predominantly of the small joints of hands and feet [1]. In daily practice as well as in research, therapy monitoring and response assessment are predominantly assessed by using the disease activity score 28 (DAS28) and correspondent response criteria as proposed by the American College of Rheumatology and the European League Against Rheumatism. The DAS28 comprises joints of the upper limbs, hands and the knees [3] but completely omits the feet. Smolen et al demonstrated that the simplified disease activity index (SDAI), which is based on the same 28 joints used for calculation of the DAS28, has the highest predictive value for the development of new erosions [6]

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