The application value of MRI in the diagnosis of subclinical inflammation in patients with rheumatoid arthritis in remission

Huimei Zhang,Huajun Xu,Shifang Chen,Xinfeng Mao

doi:10.1186/s13018-018-0866-2

Abstract

BackgroundTo explore the value of MRI in the diagnosis of subclinical inflammation in patients with early rheumatoid arthritis (RA) in remission and to predict the radiographic progression.MethodsA total of 76 of 156 patients with early RA in remission at 1 year and with available magnetic resonance imaging (MRI) data at baseline and at 12 months were included. Complete clinical and laboratory evaluations were conducted for the patients. MRI images were assessed according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Progression of bone erosions was defined as an increase of 1 or more units in annual RAMRIS score for erosions compared to baseline.ResultsAt 1 year, the majority of patients with RA in sustained remission showed some inflammatory activity on MRI (43.4% synovitis, 39.5% bone marrow edema (BME), and 9.2% tenosynovitis), and 25 of the 76 patients (32.9%) showed MRI progression of bone erosions. A significant difference was observed in MRI BME and bone erosion at 1 year, with higher mean score in patients with progression compared to non-progression of erosions (BME, 4.8 ± 3.6 vs 3.1 ± 2.1, P = 0.01; bone erosion, 13.5 ± 9.6 vs 4.4 ± 3.6, P < 0.001).ConclusionPersistent subclinical inflammations were shown in patients with sustained remission; BME in MRI may be a strong predictor of future radiographic progression of bone erosions in patients with persistent clinical remission.

Highlights

To explore the value of magnetic resonance imaging (MRI) in the diagnosis of subclinical inflammation in patients with early rheumatoid arthritis (RA) in remission and to predict the radiographic progression
Magnetic resonance imaging (MRI) is a more promising tool than clinical examination or conventional radiography, due to it performed on high field
Many reports support that MRI is more sensitive than clinical examination for detecting joint inflammation, especially subclinical inflammation; it has shown superior sensitivity compared to conventional radiography for detecting erosions in RA [4, 5, 10,11,12]

Summary

Introduction

To explore the value of MRI in the diagnosis of subclinical inflammation in patients with early rheumatoid arthritis (RA) in remission and to predict the radiographic progression. The inflammatory process of RA can result in progressive cartilage degradation with synovial hyperplasia, high levels of pro-inflammatory mediators, and change in underlying bone with erosions [3]. Diagnosis and prompt initiation of treatment are needed to improve physical function and reduce disability and joint destruction in patients with RA [4, 5]. The chief aim of treatment for patients. Imaging of inflammatory activity becomes more and more important among the available modalities [9]. Magnetic resonance imaging (MRI) is a more promising tool than clinical examination or conventional radiography, due to it performed on high field

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