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EULAR 2018 | Daily Highlights
RA: Rx and MRI
THE VALUE OF ADDING MRI TO A CLINICAL TREAT-TO-TARGET STRATEGY IN RHEUMATOID ARTHRITIS PATIENTS IN CLINICAL REMISSION: CLINICAL AND RADIOGRAPHIC OUTCOMES FROM THE IMAGINE-RA RANDOMISED CONTROLLED TRIAL
Authors: S. Møller-Bisgaard et al.
Several studies have explored the additional benefits of adding to conventional clinical outcome measures (DAS28 or others), imaging modalities or laboratory tests. The rational for these trials is that clinical outcome measures may not be sensitive enough to detect minor joint inflammation, that if undetected will continue to cause progressive joint damage.
The IMAGINE-RA study was a 2-year randomised multicentre study, which enrolled two hundred RA patients in clinical remission (DAS28-CRP<3.2 and no swollen joints) on csDMARDs. Patients were randomlised to a conventional DAS28-CRP guided treat to target (T2T) strategy or an MRI guided T2T strategy targeting absence of bone inflammation.
After two years, 88% in the conventional T2T arm versus 85% in the MRI T2T arm reached the primary clinical endpoint of DAS remission (p=0.57); and 62% in the conventional T2T arm versus 66% in the MRI T2T arm reached the primary radiographic endpoint of no radiographic progression (p=0.61).
The authors concluded that targeting absence of MRI inflammation in addition to a conventional T2T strategy in RA patients in clinical remission had no effect on the probability of achieving DAS28-CRP remission or halt radiographic progression.
This is yet another study concluding that the systematic utilization of imagery technology in patients with RA does not allow to improve clinical or radiographic outcomes over time. While clinical outcomes such as the DAS28 are not perfect, they seem adequate in most situations to detect which patients is in need of therapeutic intensification.
Zusammenfassung und Kommentar von:
Prof. Dr. Axel Finckh