MRI-guided treatment slows progression of rheumatoid arthritis

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A clinical study has found an MRI-guided treatment plan that uses a predefined treatment algorithm can prevent joint damage in rheumatoid arthritis patients.

The chronic inflammatory joint disease mostly affects hands and feet—it can cause pain, functional impairments, reduced quality of life and joint damage over time, says Kim Horslev-Petersen, MD, a professor of rheumatology at King Christian X Hospital for Rheumatic Diseases in Sonderjylland, Demark.

Current protocols require early and intensive treatment with follow-up to avoid inflammation and resulting joint damage, so methods used for diagnosis monitoring and prognostication are highly sensitive.

“Erosive joint damage occurs early in the disease,” Horslev-Petersen says. “Joint deformity is irreversible and causes serious functional impairment. Early and intensive treatment with close monitoring of the inflammation can slow the destructive disease and prevent function loss.”

However, patients getting conventional clinical and biochemical exams that show low disease activity or remission can still have progressive joint damage, and Horslev-Petersen suggests that current clinical and biochemical treatments commonly used are not sufficiently sensitive to monitor disease progression, but an MRI examination can bring more clarity to treatment options.

“The presence of erosions, shown by X-ray examination, as well as anti-cyclic citrullinated peptide antibodies and bone marrow oedema on magnetic resonance imaging, are all independent predictors of subsequent radiographic progression,” he contends. Bone marrow oedema has been shown to be the strongest independent predictor in early RA, and MRI and therefore has significant prognostic value.”

Consequently, he adds, it is possible to prevent radiographic erosive progression, improve functional level and enable more patients to achieve clinical remission, Horslev-Petersen concludes.

The complete study is available at the U.S. National Library of Medicine’s web site with an identifier of NCT01656278.

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