Abstract
BackgroundRemission is arguably the ultimate therapeutic goal in rheumatoid arthritis (RA). Applying modern strategies, clinical remission can be achieved in a substantial number of patients with early RA (ERA). Even in those patients, the number and scope of erosions can increase. We, therefore, investigated the value of MRI for the detection of radiological progression in patients with DAS28 improvement and/or clinical remission of the German Remission-plus cohort.MethodsData-sets of 80 RA patients (according to 2010 ACR/EULAR criteria) from the Remission-plus study cohort, who fulfilled the following criteria, were retrospectively analysed: availability of two consecutive MRI scans (low-field MRI, follow-up interval 1 year) of the clinically dominant hand and wrist, and the presence of DAS28 (CRP) scores at both time points, which was used to assess disease activity.ResultsSeventy-one of the 80 investigated patients presented a numerical improvement of the DAS28 (CRP) after 12 months (DAS28(CRP) T0 average (Ø) 4.96, SD 1.2; DAS28 T4 (12 month) Ø 2.6, SD 1.0), 73% of them also improved in the RAMRIS-Score, while 24% demonstrated an increase despite DAS28 improvement and 3% showed equal values. 48% of patients who improved in the DAS28 reached EULAR remission. 41% of these patients had an increase in the RAMRIS Erosion-subscore after 12 months. When considering EULAR response criteria (non-response (n = 7), moderate response (n = 19), good response (n = 45)), an increase of erosions was found in 71.4% of non-responders, 52.6% of moderate responders, and 31.1% of good responders after 12 months, all compared to baseline.ConclusionUp to 40% of patients in this study demonstrated a progressive erosive disease detected by MRI despite DAS28 improvement or EULAR remission. Future studies are needed to determine the prognostic clinical impact of disease progression in MRI despite clinical remission, and to investigate if DAS28 remission may be an insufficient therapeutic goal and should be accompanied by MRI remission criteria.
Highlights
Remission is arguably the ultimate therapeutic goal in rheumatoid arthritis (RA)
The American College of Rheumatology (ACR) response criteria, which rely on a relative change of five core set variables [6], and the European League Against Rheumatism (EULAR) response criteria, which are based on an absolute change of the composite Disease Activity Score in 28 joints (DAS28) including the ACR/EULAR remission criteria [7,8,9], are most common
Clinical improvement and Magnetic resonance tomography (MRI) results Seventy-one of the 80 analysed patients presented a clinical improvement of the DAS28 after 12 months (T4), while two showed a stable disease activity and 7 worsened (DAS28(CRP) T0 average (Ø) 4.96; SD 1.2; DAS28 T4 (12 month) Ø 2.6; SD 1.0) (Fig. 1)
Summary
Remission is arguably the ultimate therapeutic goal in rheumatoid arthritis (RA). Clinical remission can be achieved in a substantial number of patients with early RA (ERA). Even in those patients, the number and scope of erosions can increase. This goal can be achieved in the majority (up to 80%) of patients with early RA (ERA) [3]. In this context, remission has been defined as a “state of absent disease activity”. The American College of Rheumatology (ACR) response criteria, which rely on a relative change of five core set variables [6], and the European League Against Rheumatism (EULAR) response criteria, which are based on an absolute change of the composite Disease Activity Score in 28 joints (DAS28) including the ACR/EULAR remission criteria [7,8,9], are most common
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