gms | German Medical Science

45. Kongress der Deutschen Gesellschaft für Rheumatologie, 31. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 27. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

06.09. - 09.09.2017, Stuttgart

Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) can predict DAS-28 therapy response: Results of the German ArthroMark cohort

Meeting Abstract

  • Philipp Sewerin - Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, UKD, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
  • Lien Le - Ludwig Maximilian Universität, Institut für Medizinische Informatik, Biometrie und Epidemiologie, München
  • Stefan Vordenbäumen - Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, UKD, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
  • Christoph Schleich - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
  • Ruben Sengewein - Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, UKD, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
  • Ralph Brinks - Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, UKD, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
  • Georg Pongratz - Universitätsklinik Düsseldorf, Poliklinik, Funktionsbereich und Hiller Forschungszentrum Rheumatologie, Düsseldorf
  • Ulrich Mansmann - Ludwig Maximilian Universität, Institut für Medizinische Informatik, Biometrie und Epidemiologie, München
  • Matthias Schneider - Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, UKD, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
  • Benedikt Clemens Ostendorf - Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, UKD, Heinrich-Heine-Universität Düsseldorf, Düsseldorf

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 45. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 31. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), 27. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Stuttgart, 06.-09.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.05

doi: 10.3205/17dgrh049, urn:nbn:de:0183-17dgrh0497

Published: September 4, 2017

© 2017 Sewerin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: Remission is the ultimate goal in rheumatoid arthritis (RA). The absence of RF and /or CCP antibodies, the presence of low disease activity and early therapeutic intervention are established good prognostic markers. No bone erosions on conventional x-rays serve still as the imaging marker, although magnetic resonance imaging (MRI) is increasingly used in daily practice. Nevertheless, the predictive role of MRI concerning response or remission is still under research. In this study, we prospectively investigated the 6 months prognostic performance of high-field MRI and serological biomarkers after initiation of methotrexate (MTX) in patients with early RA (eRA)

Methods: Prospective cohort study on the ArthroMark cohort using 3-T MRI including dynamic MRI-sequences and Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) of the clinical dominant hand at baseline (V0) before initiating an MTX-therapy in eRA patients, after three 3 (V3) and after 6 months (V6). 28 patients (Ø 56.8 years (range 39 - 74) with RF and/or CCP positive RA and a disease duration < 6 months (mean 16.3 weeks, range 2 - 23) fulfilling the 2010 ACR/EULAR criteria were examined. The following biomarkers were assessed by ELISA: Dkk-1, Osteoprotegerin, RANKL, MMP-3 and Neuropeptide-Y. MRI-scans were analysed by using OMERACT RA-MRI scoring system (RAMRIS). To adjust for intrapersonal correlation, we calculated generalized linear mixed models with time being recognized as a confounder in pretests.

Results: A low RAMRIS subscore for erosions (p=0.019) or a total RAMRIS score predicted response at V3 (p=0.03). No significant results were found for the other imaging markers assessed for response prediction at either V3 or V6. Concerning remission, low levels of RANKL at baseline were significantly associated with EULAR remission at V6 (p=0.033). The other imaging and serological markers assessed did not show significant results at either V3 or V6. In multivariate analyses, response at 3 and 6 month was predicted more accurately with the inclusion of either RAMRIS total-score (p value LR-test = 0.035), RAMRIS synovitis subscore at MCP-2 (p-value LR-test = 0.035) or a combination of the two (pvalue LR-test = 0.042). Remission was more accurately predicted when RANKL was considered with low RANKL improving the chance of remission. In contrast to response-prediction, adding MRI did not significantly improve model fit for remission.

Conclusion: Low RAMRIS scores or RAMRIS synovitis subscores at MCP-2 were significantly associated with therapy response in our longitudinal analysis. Baseline RANKL was shown to significantly associate with EULAR remission. Our data suggests that MRI and/or biomarkers may aid response prediction and facilitate patient selection for intensified therapy in the future.