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Magnetic resonance imaging in rheumatoid arthritis clinical trials: emerging patterns based on recent experience

Charles G Peterfy1, Peter Countryman, Annarita Gabriele

  • 1Spire Sciences, LLC, San Francisco, CA, USA. Charles.peterfy@spiresciences.com

The Journal of Rheumatology
|September 3, 2011
PubMed
Abstract

Insights

Excluding specific wrist bones in magnetic resonance imaging (MRI) scoring for rheumatoid arthritis (RA) enhances the detection of structural changes over time. This refined RA MRI Score (RAMRIS) improves sensitivity in clinical trials.

Area of Science:

  • Rheumatology
  • Radiology
  • Medical Imaging

Background:

  • The current RA MRI Score (RAMRIS) includes most metacarpophalangeal (MCP) and wrist joints.
  • Radiographic scoring suggests excluding certain wrist bones improves sensitivity to changes over time.
  • Optimizing MRI scoring is crucial for accurately assessing rheumatoid arthritis progression in clinical trials.

Purpose of the Study:

  • To determine the optimal combination of MCP and wrist joints for sensitive and discriminative assessment of structural changes in rheumatoid arthritis (RA) using MRI.
  • To evaluate the impact of excluding specific wrist bones on the discriminative power of the RAMRIS scoring system.

Main Methods:

  • Utilized MRI data from 522 RA patients across 4 multicenter randomized controlled trials (RCT).
  • Assessed erosion, osteitis, and synovitis using the RAMRIS system; joint-space narrowing (JSN) was also evaluated.
  • Compared the sensitivity and reliability of 7 different joint combinations for detecting structural changes at Weeks 12 and 24.

Main Results:

  • Variability in the frequency of involvement and reliability of assessment was observed across different joint locations.
  • Excluding specific wrist bones resulted in a higher percentage of subjects demonstrating changes greater than or equal to the smallest detectable change (SDC).

Conclusions:

  • Excluding wrist bones that show infrequent or unreliable structural changes enhances the discriminative power of the RAMRIS scoring system.
  • This optimization can lead to more sensitive detection of treatment effects and disease progression in RA clinical trials.

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