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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses results from a series of studies that assessed the use of magnetic resonance imaging (MRI) to identify subclinical inflammation. The objectives of the study were to define the MRI characteristics of clinical remission and low disease activity (Outcome Measures in Rheumatoid Arthritis Clinical Trials [OMERACT] 10 criteria), to determine the predictive factors for structural progression in these patients, and to identify an MRI cutoff for nonprogression.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMagnetic Resonance Imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatoid Arthritis\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ETreatment of rheumatoid arthritis (RA) has improved substantially in the past decade, and a state of remission (generally defined as the absence of inflammatory activity, based on clinical criteria) or low disease activity (LDA) is now a realistic goal that is achieved by a substantial proportion of patients. Although patients may be in clinical remission or have LDA, radiographic structural progression may occur and has been noted in magnetic resonance imaging (MRI) findings. It has also been suggested that patients with MRI findings that are indicative of inflammation are more likely to progress to radiographic joint destruction. Taken together, these observations suggest that the inclusion of a definition of MRI remission may be clinically relevant to future definitions of remission in patients with RA. What is not clear, however, is whether or not there is a critical amount of MRI inflammation (eg, synovitis and\/or bone edema) below which RA is not likely to progress to joint destruction.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EEspan A. Haavardsholm, MD, Diakonhjemmet Hospital, Oslo, Norway, reported results from a series of studies that assessed the use of MRI to identify subclinical inflammation. The objectives of the study were to define the MRI characteristics of clinical remission and LDA (Outcome Measures in Rheumatoid Arthritis Clinical Trials [OMERACT] 10 criteria), to determine the predictive factors for structural progression in these patients, and to identify an MRI cutoff for nonprogression.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDatabases from 6 cohorts were collected from 5 international centers. The study assessed 294 RA patients (70% women, median age 55 years, disease duration 2.3 years, Disease Activity Score 28-C-reactive protein [DAS28-CRP] 2.2, Simplified Disease Activity Index [SDAI] 3.9, and Clinical Disease Activity Index [CDAI] 3.1). More than half (57%) of the participants were rheumatoid factor (RF)-positive; 54% were anti-cyclic citrullinated peptide-positive; 66% had radiographic erosions. A total of 213 patients (74%; 213\/287) were considered to be in clinical remission (DAS28-CRP \u0026lt;2.6); 81 were classified as having LDA (DAS28-CRP 2.6 \u2264 but \u0026lt;3.2). MRIs were assessed according to the OMERACT RA MRI scoring system (RAMRIS). MRI inflammatory activity in wrist and\/or metacarpophalangeal joints was observed in the majority (synovitis, 95%; bone edema [osteitis], 35%) of patients. The median (IQR) RAMRIS score was 6 (3 to 9) for synovitis and 0 (0 to 2) for osteitis. Synovitis and osteitis were not less frequent in DAS28 clinical remission (synovitis\/osteitis 96%\/35%) than in LDA (91%\/36%). A trend toward lower frequencies of osteitis in patients in SDAI and CDAI remission was observed [Gandjbakhch F et al. \u003Cem\u003EJ Rheumatol\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe following steps were undertaken using an underlying conditional logistic regression model that was stratified per cohort, with radiographic progression as the dependent variable:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-6\u0022\u003EStep 1: Multivariate stepwise regression with baseline DAS28-CRP, age, disease duration, RF status, disease activity (low vs remission), biologic treatment, disease-modifying antirheumatic drugs (DMARD) treatment, RAMRIS synovitis, erosions and bone marrow edema\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-7\u0022\u003EStep 2: Receiver operating characteristic analysis used to identify the best cutoff point(s)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022\u003EStep 3: Analysis with the identified cutoff point(s) in the model\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-9\u0022\u003EStep 4: Identification of possible interaction effects (several possible effects were included, such as disease activity (low\/remission), biologic\/DMARD treatment, and RF)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-10\u0022\u003EStep 5: Final model with interaction effects\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-11\u0022\u003EFollowing Step 1, only RAMRIS synovitis was identified as a significant predictor and was entered into the next model (p\u0026lt;0.01). A simple ROC analysis identified a cutoff value for RAMRIS synovitis of 6 (0 to 6 vs \u22657); however, after an additional analysis to test different models with possible cutoffs in the range of 4 to 7 and applying Akaike\u0027s Information Criterion, the model with the best fit was the model with a synovitis cutoff of \u22656 versus 0 to 5. Step 3 yielded a significant model with an odds ratio for progression of 2.42 (95% CI, 1.236 to 4.724; p=0.01) for above versus below the cutoff value of synovitis. In Step 4, RF status yielded a significant interaction with synovitis (interaction p=0.044). The final estimates show that patients who are RF-positive and have a RAMRIS synovitis score of \u22656 have an odds ratio of 4.4 for radiographic progression versus those with a synovitis score of \u22645 (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14222\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14222\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14222\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EFinal Estimates.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003ELess than 20% (n=21) of RF-negative patients progressed radiographically, while 27% (n=36) of RF-positive patients progressed. Of the RF-positive patients who did progress, 42% (n=28) had a RAMRIS synovitis score \u0026gt;5, whereas \u0026lt;12% (n=8) of RF-positive patients with RAMRIS synovitis score 0 to 5 progressed.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EThe strengths of this study include a large patient population and the use of experienced readers and RAMRIS at all centers. The results may be limited by the fact that there were multiple readers, the follow-up times differed at the individual centers (6 to 12 months), and different joint areas were assessed by radiograph and MRI.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EThe investigators concluded that RF-negative patients and RF-positive patients who are in remission or have LDA and who have a RAMRIS synovitis score \u22645 have a favorable prognosis with regard to nonprogression of radiographic damage. High RAMRIS synovitis score is a strong predictor of radiographic progression.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EThe authors further concluded that, from a clinical perspective, RF-positive patients who are in clinical remission or have LDA could benefit from an MRI scan for risk stratification. They recommend that RF-positive patients with RAMRIS synovitis scores \u22656 should continue to be closely monitored, while patients with scores of \u22645 may be candidates for less rigorous follow-up and possible step-down therapy.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/9\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzngd1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzngd1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}