Short-term changes on MRI predict long-term changes on X-ray MRI is a valid method for monitoring joint damage in short-duration randomised clinical trials.
INTRODUCTION
Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. Although many treatments that stop inflammation and joint destruction have been introduced over the past 20 years, there is still no cure for rheumatoid arthritis, and most people do not achieve the control over their disease that they would like. With this in mind, new treatments are still being developed.
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. These are used in trials of new drugs to see whether they stop joint damage and reduce inflammation. However, there can be challenges with the use of imaging. For example, X-rays cannot detect changes over periods less than 6 months, but many trials are shorter than this because it is not ethical to leave people on a placebo (dummy) drug for more than 3 months when there are good treatment options already available. MRI is more sensitive than X-ray for detecting joint damage, and it can also see the underlying inflammation. This means that MRI might be a better imaging technique to use in trials, but at the moment the regulatory bodies that review and approve new drugs in the US and Europe do not accept MRI data.
WHAT DID THE AUTHORS HOPE TO FIND?
In 2013, a task force from the American College of Rheumatology (ACR) recommended that recent trials that included both X-ray and MRI should be reviewed to see if MRI could predict joint damage. Based on this, the authors hoped to show that MRI is a useful tool for evaluating people’s disease progression and their response to treatment in clinical trials. They aimed to do this by seeing whether short-term changes in inflammation and joint damage that could be seen on an MRI predicted longer-term changes in joint damage seen on an X-ray.
WHO WAS STUDIED?
This study looked at 1022 hands and wrists. Everyone included had active rheumatoid arthritis despite previous treatment.
HOW WAS THE STUDY CONDUCTED?
This was a pooled review of the results from four previously published clinical trials in people with rheumatoid arthritis that included both X-ray and MRI. This means that there were no new studies conducted. All four of the studies included looked at potential new treatments compared to a placebo (dummy) drug. The authors of this review looked at data from these previous studies to see whether MRI changes over 12 and 24 weeks could predict changes seen on X-ray over 24 weeks and 52 weeks.
WHAT WERE THE MAIN FINDINGS?
The review found that changes in joint damage and inflammation on MRI over 12 weeks each predicted joint damage that could be seen on X-ray at 24 weeks. It also found that changes seen with MRI over 24 weeks predicted changes seen on X-ray at 52 weeks.
ARE THESE FINDINGS NEW?
No, similar findings have already been reported on one of the four studies included in this investigation. However, this study supported those results, and showed that they can be generalised to other studies by pooling data from multiple clinical trials.
ARE THERE ANY LIMITATIONS?
In this study the data were anonymised to maintain confidentiality. Also, for ethical reasons the studies were designed so that people receiving placebo who did not improve were able to have active treatment at 16 to 24 weeks. This would have decreased long-term X-ray progression among some people who had shown short-term progression on MRI, and could have artificially lowered how well MRI predicted the X-ray outcomes. This means that the true predictiveness of MRI is likely to be better than seen in this study.
WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
The authors hope that further discussions with regulatory authorities will ensure that they endorse MRI as an acceptable imaging technique in clinical trials in rheumatoid arthritis.
WHAT DOES THIS MEAN FOR ME?
In the future, the use of MRI in trials of new drugs in rheumatoid arthritis could mean that it is possible to evaluate the drugs in less time and with fewer people than is currently possible with trials that use X-ray. This might help to develop new drugs quicker, and you could have more treatment options available to you.
If you have rheumatoid arthritis, your doctor might use MRI early in your disease to check for joint damage. They can then use this information to make treatment decisions for you. Using MRI can also help to see if you need your treatment adjusted or replaced in order to limit or prevent irreversible joint damage and your risk of disability.
If you are interested in being involved in clinical trials you should speak to your doctor.
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Date prepared: June 2017
Summary based on research article published on: 14 December 2016 From: Peterfy, C. et al. Short-term changes on MRI predict long-term changes on radiography in rheumatoid arthritis: an analysis by an OMERACT Task Force of pooled data from four randomised controlled trials. Ann Rheum Dis 2017;76:992–997. doi:10.1136/annrheumdis-2016-210311
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