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The MRI Features in Patients with Rheumatoid Arthritis Treated with Tocilizumab, in Clinical Remission or Low Disease Activity State

Bensaoud Nada, Samira Rostom, Rachid Bahiri and Najia Hajjaj-Hassouni

Background: Subclinical inflammation and radiographic progression have been described in rheumatoid arthritis (RA) patients whose disease are in remission or are showing a low level of activity. The aim of this study was to evaluate in patients with rheumatoid arthritis RA in clinical remission or low disease activity (LDA) using composites scores, the synovitis and the bone oedema using MRI by OMERACT RAMRIS score (RAMRIS bone oedema and synovitis RAMRIS).

Methods: In this longitudinal study, were included patients with rheumatoid arthritis according to the American College of Rheumatology ACR 2010 criteria with inadequate response or intolerance to conventional synthetic DMARD, treated with Tocilizumab (TCZ). Sociodemographic characteristics, clinical and laboratory for the disease were collected at baseline (M0) and 06 months (M6) of treatment. Clinical remission was defined by a DAS 28- ESR<2.6, a CDAI<2.8, a SDAI<3.3 and by ACR EULAR criteria. All patients underwent MRI of the dominant hand and wrist. MRI features were evaluated according to the Outcome Measure Clinical Trial in Rheumatoid Arthritis Rheumatoid Arthritis MRI Scoring system (OMERACT RAMRIS synovitis and bone oedema).

Results: 22 patients with RA were included, 19 females (86.4%), with a mean of age 42 ± 13.7 years. The mean disease duration was 8 ± 5.2 years. The mean DAS 28 was 5.8 ± 0.94. Three patients were excluded from the study for serious side effects. At 06 months, the median SDAI was 18 (10-27).The median CDAI was 10 (5-20).The mean RAMRIS score was 2.23 ± 6.33 for bone oedema, 4.76 ± 4.02 for synovitis and 43.32 ± 30 for erosion. Using DAS28ESR as criteria of remission, it did not exist significant differences between the 3 groups of patients (remission/LDA/active disease) for the presence of synovitis on MRI (p=0.43). There was also no difference between the three groups for the presence of bone oedema (p=0.08). Moreover, defining remission by SDAI, CDAI or ACR EULAR criteria, the RAMRIS synovitis and bone oedema RAMRIS did not differ by the level of disease activity. Conclusion: This study suggests that patient in clinical remission or LDA evaluated by composites scores showed inflammation (synovitis and bone oedema) on MRI. Thus clinical remission would be different from the imaging remission. MRI and ultrasound are currently one of the criteria for remission in RA, further studies are needed in particular to determine the threshold definition of remission on MRI.