Vol.23 No.2

Original Article

Significant improvement in MRI-proven bone edema is associated with protection from structural damage in very early RA patients managed using the tight control approach

Authors

Junko Kita1 , Mami Tamai2 , Kazuhiko Arima3 , Shin-ya Kawashiri3 , Yoshiro Horai1 , Naoki Iwamoto1 , Akitomo Okada1 , Tomohiro Koga1 , Yoshikazu Nakashima1 , Takahisa Suzuki1 , Satoshi Yamasaki9 , Hideki Nakamura1, Tomoki Origuchi4, Hiroaki Ida5, Kiyoshi Aoyagi6, Masataka Uetani7, Katsumi Eguchi8, Atsushi Kawakami1

  • Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Center for Health & Community Medicine, Nagasaki University, Nagasaki, Japan
  • Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
  • Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Department of Radiology and Radiation Research, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Sasebo City General Hospital, Sasebo, Japan
  • Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
Received:

2 December 2011

Accepted:

26 March 2012

Published online:

6 June 2012

Full Text

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Abstract

Objective To identify the value of magnetic resonance imaging (MRI)-proven bone edema in patients with very early rheumatoid arthritis (RA).
Methods All of the 13 patients included in the study were positive at entry for MRI-proven bone edema of the wrist and finger joints and anti-cyclic citrullinated peptide antibodies or IgM-rheumatoid factor. A tight control approach was applied for 12 months. Plain MRI and radiographs of both wrist and finger joints were examined every 6 months. MRI was scored by theRAMRI scoring(RAMRIS) technique and plain radiographs were scored using the Genant-modified Sharp score. Variables that were correlated with plain radiographic changes at 12 months were examined.
Results Simplified disease activity index (SDAI) remission was achieved in 7 patients, and a significant reduction in the RAMRIS bone edema score, which declined to <33 % as compared with the baseline, was achieved in 8 out of 13 patients. Four patients showed plain radiographic progression while 9 patients did not. Significant reductions in the RAMRIS bone edema score (p = 0.007) and the time-integrated SDAI (p = 0.031) were the variables involved in plain radiographic progression.
Conclusions Improvement in bone edema may be associated with protection against structural damage in very early RA patients managed using the tight control approach.

Key words

Very early RA - MRI - RAMRIS bone edema score - SDAI - Radiographic progression