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Differing time-orders of inflammation decrease between ACPA subsets in RA patients suggest differences in underlying

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Inflammation in rheumatoid arthritis (RA) tissues like synovitis and tenosynovitis decreases simultaneously with DMARD treatment. Synovitis inflammation reduction consistently precedes tenosynovitis reduction, offering insights into RA treatment response.

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Area of Science:

  • Rheumatology
  • Medical Imaging

Background:

  • Advanced imaging reveals inflammation in joints, bones, and tendon sheaths in rheumatoid arthritis (RA) at diagnosis.
  • Understanding the sequence of tissue inflammation response to disease-modifying antirheumatic drug (DMARD) treatment is crucial for optimizing therapy.
  • Anti-citrullinated protein antibody (ACPA) status may indicate different pathophysiological pathways, potentially influencing treatment response timing.

Purpose of the Study:

  • To elucidate the temporal sequence of inflammatory tissue response during conventional synthetic DMARD treatment in RA patients.
  • To investigate potential differences in the timing of inflammation decrease between ACPA-positive and ACPA-negative RA subgroups.

Main Methods:

  • A cohort of 216 patients with RA or undifferentiated arthritis initiating DMARD therapy was studied.
  • Contrast-enhanced 1.5T hand and foot MRIs were acquired at baseline and at 4, 12, and 24 months.
  • Cross-lagged models analyzed simultaneous and subsequent patterns of change in inflammatory features, with ACPA stratification.

Main Results:

  • All inflammatory features (synovitis, tenosynovitis, osteitis) demonstrated simultaneous decrease across all time intervals (P < 0.05).
  • A significant time-order was observed: synovitis decrease preceded tenosynovitis decrease (P = 0.02 and P = 0.03).
  • In ACPA-positive patients, synovitis decrease also preceded osteitis decrease (P = 0.002), a pattern not seen in ACPA-negative patients.

Conclusions:

  • DMARD treatment leads to simultaneous reduction in multiple inflammatory RA manifestations.
  • The sequential reduction of synovitis before tenosynovitis provides a refined understanding of RA treatment dynamics.
  • Differential timing of inflammation decrease in ACPA subgroups suggests distinct underlying inflammatory mechanisms and potential therapeutic implications.