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MRI Measures of Synovitis in RA, a Valuable Endpoint

MRI Measures of Synovitis in RA, a Valuable Endpoint

Research has historically shown there is great value in considering patient reported outcomes to assess disease status — but this can be tricky. Patient reported outcomes are seldom clear-cut. Comorbidities and other conditions could worsen or improve disease status muddying the effects of treatment protocols prescribed for conditions like rheumatoid arthritis.

MRIs can provide physicians with more accurate assessments of inflammation and joint damage like synovitis, osteitis, tenosynovitis, erosions and JSN in rheumatoid arthritis patients. 

But how closely aligned are patient-reported outcomes and MRI measures? Are they in agreement? Writing in the March 1 print issue of the Annals of the Rheumatic Diseases, researchers led by Joshua F. Baker, M.D., of the University of Pennsylvania, find that MRI measures appear to be on target with patient-reported outcomes of physical function, pain and patient global assessment of disease activity (PtGl).

The new study in ARD is based on data from the randomized, controlled "Golimumab Before Employing Methotrexate as the First-Line Option in the Treatment of Rheumatoid Arthritis of Early Onset (GO-BEFORE)" MRI trial and the "Golimumab in Active Rheumatoid Arthritis Despite Methotrexate Therapy" trial.

The team assessed whether MRI measures of synovitis, osteitis and bone erosion correlated with physical function, pain patient-reported outcomes (PROs) in a 52-week study of 291 patients with rheumatoid arthritis. Scores were taken at four-week intervals for synovitis, osteitis, and bone erosion (RAMRIS); as well as scores for pain, physical function (with the Health Assessment Questionnaire, or HAQ) and global patient scores.

Baker et al found that greater synovitis, osteitis and bone erosion scores were positively associated with HAQ at zero, 12, 24 and 52 weeks and with pain and patient global scores at 24 and 52 weeks. Overall, synovitis was associated with HAQ, pain and patient global scores independent of clinical disease activity measures. MRI-confirmed improvements in synovitis corresponded with improvements in patient-reported outcomes. Specifically, at 52 weeks, the reduction in MRI-detected synovitis was significantly correlated to improvements in HAQ, pain and patient global scores.

“These observations suggest that MRI measures of synovitis may be a reasonable surrogate end point in observational and early interventional studies,” the researchers wrote.

Improvements in inflammation and deterioration as shown on MRI correlated with improvements in physical function, pain and patient global scores suggesting that MRI findings may align with PROs.

In a commentary that accompanied the article, Veena K. Ranganath, M.D., of UCLA, and Vibeke Strand, M.D., a rheumatologist and adjunct clinical professor with Stanford University School of Medicine, described the paper as a “thought-provoking” analysis.

“Baker et al highlights a critical demonstration that inhibition of inflammation and progression of structural damage directly impacts reported pain of patients with rheumatoid arthritis and physical function, and positively influences their assessment of disease activity,” they wrote in their commentary.

In summary:

  • MRI measures correlated with physical functioning over the entire study period.
  • Less improvement in synovitis and MRI erosion progression were independently associated with associated with unfavorable changes in HAQ, pain and PtGl score at 1 year.
  • Unfavorable changes in HAQ, pain and PtGl score at one year were associated with synovitis that did not improve significantly and greater bone erosion scores that were confirmed by MRI.
  • Synovitis was associated with all PROs independent of clinical disease activity.
  • In terms of Osteitis, the findings confirmed what prior studies have shown:  Osteitis was not significantly associated with patient-reported outcomes.

Disclosures

JFB is supported by a Veterans Affairs Clinical Science Research and Development Career Development Award (IK2 CX000955).

References

Joshua F Baker, Philip G Conaghan, Paul Emery, Daniel G Baker, Mikkel Ostergaard. "Relationship of patient-reported outcomes with MRI measures in rheumatoid arthritis," ARD. March 1, 2017. http://dx.doi.org/10.1136/annrheumdis-2016-209463
 
 
Veena K Ranganath, Vibeke Strand. "Importance of ‘meeting of the minds’: patient-reported outcomes and MRI," ARD. March 1, 2017. http://dx.doi.org/10.1136/annrheumdis-2016-210058
 
 

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