MRI measures of inflammation and structural damage correlate independently with physical function, pain and patient global assessments
Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. It is more common in older people, and affects both men and women.
The use of patient-reported outcomes (often shortened to PROs) helps to improve communication between
people and their doctors. However, PROs do not always reflect the inflammatory disease burden and can be influenced by other underlying conditions. Therefore disagreement between people and their doctor about the impact of severity of the disease is common.
Imaging techniques allow doctors to see inside the joints to assess any damage and to monitor disease activity and progression (worsening). Common imaging techniques include X-ray, magnetic resonance imaging (MRI) and ultrasound.
WHAT DID THE AUTHORS HOPE TO FIND?
MRI detects joint inflammation more accurately than clinical examination. Recent work has suggested that measuring disease activity in rheumatoid arthritis by MRI may be useful in understanding an individual’s longterm outcome and understanding responses to therapies. However, few studies have looked at whether these measurements correlate with how patients experience their own disease.
WHO WAS STUDIED?
This study looked at 291 people with rheumatoid arthritis from all over the world. Everyone was over the age of 18 and had been diagnosed with rheumatoid arthritis for at least 3 months.
HOW WAS THE STUDY CONDUCTED?
This was a sub-study of a larger trial called GO-BEFORE – a double-blind, randomised clinical trial. The main aim of the original study was to determine how well a particular therapy worked. This sub-study looked only at the MRI and clinical data.
Wherever possible, people enrolled in the clinical trial had an MRI of their hand to see if they had inflammation in their wrist and finger joints. The authors looked at how the measures of inflammation and damage in the wrist and fingers compared to the way that patients reported their disease (in terms of how well they were able to do their daily activities, and if they were in pain). They also evaluated whether improvements seen on the MRI during the trial connected to the improvements seen in the PROs.
WHAT WERE THE MAIN FINDINGS?
Overall, the study found that people with rheumatoid arthritis who had more inflammation in their joints also reported greater pain and disability. There was also greater improvement in pain and disability in people who had improvements in the joint inflammation on MRI. People with more damage (as measured by bone damage in the joints) also had worse pain and disability at later points in the trial.
ARE THESE FINDINGS NEW?
This is the first study that we are aware of that suggests that effectively treating MRI-detected inflammation is also likely to affect how the patient feels. This is important as doctors often think about using MRI only to measure the disease.
ARE THERE ANY LIMITATIONS?
This study is limited because it is only one group of people and it was performed in a clinical trial setting. More data in “real-world” settings will be helpful to understand these relationships in people who have had their disease for a longer time, and who have less active inflammation in their joints.
WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
Future studies in other groups of people are an important next step. While this study suggests that the inflammation on an MRI is important to how people experience their disease, further studies are needed to better understand how to use this information in practice.
WHAT DOES THIS MEAN FOR ME?
At the moment, most rheumatologists do not use imaging or other advanced testing to measure disease activity. If you have rheumatoid arthritis, your assessment is typically done with physical examination and other assessments performed in the clinic. However, in the future, MRI or other measures of disease activity may be used more frequently to assess the severity of your disease and decide how you should be treated.
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Date prepared: March 2017
Summary based on research article published on: 18 July 2016
From: Baker, JF. et al. Relationship of patient-reported outcomes with MRI measures in rheumatoid arthritis. Ann Rheum Dis 2017;76:486–490. doi:10.1136/annrheumdis-2016-209463.
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