SAT0634 Does the presence of mri-detected osteitis at diagnosis with rheumatoid arthritis lowers the risk for achieving dmard-free sustained remission? – results of a longitudinal study. (12th June 2018)

• Record Type: Journal Article
• Authors: Burgers, L.E.; Boeters, D.M.; Reijnierse, M.; van der Helm-van Mil, A.H.M.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1168
• Page End: 1168
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.3431
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Although infrequent, some rheumatoid arthritis (RA)-patients achieve disease-modifying antirheumatic drug (DMARD)-free sustained remission. Absence of RA-specific auto-antibodies, such as anticitrullinated protein antibodies (ACPA) are known to be associated with this outcome, but furthermore mechanisms underlying the chronic nature of RA are largely unknown. Objectives: Magnetic resonance imaging (MRI)-detected bone marrow oedema (BME, osteitis) strongly predicts erosive progression and is associated with ACPA-positivity. Therefore, we hypothesised that presence of MRI-detected osteitis is also predictive of not achieving DMARD-free sustained remission and that the presence of osteitis mediates the association between ACPA and DMARD-free sustained remission. Methods: A 1.5T unilateral hand and foot MRI was performed at disease presentation in 238 RA-patients, evaluating BME, synovitis and tenosynovitis (summed in MRI-inflammation score). The median follow-up duration was 3.8 years. DMARD-free sustained remission, defined as the absence of clinical synovitis after DMARD-cessation that persisted during the total follow-up, was assessed. Associations between the different MRI-detected inflammatory features and this outcome were studied. A mediation analysis was performed to study whether the presence of BME mediated the association between ACPA and DMARD-free sustained remission. Finally, patterns of MRI-detected inflammation (including type, severity and location) with regard to DMARD-free sustained remission were studied using partial least squares (PLS) regression. Results: Forty-six (19.3%) patients achieved DMARD-free sustained remission. ACPA-positivity associated independently with remission (HR 0.16, 95% CI 0.06–0.39). In contrast, no associations were observed between MRI-detected BME (HR 0.99, 95% CI 0.94–1.03), or other MRI-inflammatory features, and achieving DMARD-free sustained remission. Thus, the presence of BME did not mediate the association between ACPA and DMARD-free sustained remission Furthermore, PLS regression revealed that patients who did or did not achieve remission could not be distinguished by patterns of MRI-detected inflammation. Conclusions: At disease presentation, osteitis, as well as other MRI-detected inflammatory features, were not associated with achieving DMARD-free sustained remission over time. The data indicate that imaging predictors for joint damage and disease persistence differ. The processes mediating RA chronicity remain largely unsolved. Disclosure of Interest: None declared