Structural Changes over a Short Period Are Associated with Functional Assessments in Rheumatoid Arthritis

Tomohiro Shimizu; Ana Cruz; Matthew Tanaka; Kenji Mamoto; Valentina Pedoia; Andrew J Burghardt; Ursula Heilmeier; Thomas M Link; Jonathan Graf; John B Imboden; Xiaojuan Li

doi:10.3899/jrheum.180496

Structural Changes over a Short Period Are Associated with Functional Assessments in Rheumatoid Arthritis

J Rheumatol. 2019 Jul;46(7):676-684. doi: 10.3899/jrheum.180496. Epub 2019 Feb 15.

Authors

Tomohiro Shimizu^{1

2}, Ana Cruz^{3

4}, Matthew Tanaka^{3

4}, Kenji Mamoto^{3

4}, Valentina Pedoia^{3

4}, Andrew J Burghardt^{3

4}, Ursula Heilmeier^{3

4}, Thomas M Link^{3

4}, Jonathan Graf^{3

4}, John B Imboden^{3

4}, Xiaojuan Li^{3

4}

Affiliations

¹ From the Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, and the Department of Medicine, Division of Rheumatology, and the School of Pharmacy, at the University of California, San Francisco (UCSF), San Francisco, California; Department of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan. [email protected].
² T. Shimizu, MD, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF, and Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University; A. Cruz, BS, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, and School of Pharmacy, UCSF; M. Tanaka, BS, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; K. Mamoto, MD, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF, and Department of Biomedical Engineering, PAMI, Cleveland Clinic; V. Pedoia, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; A.J. Burghardt, BS, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; U. Heilmeier, MD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; T.M. Link, MD, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; J. Graf, MD, Department of Medicine, Division of Rheumatology, UCSF; J.B. Imboden, MD, Department of Medicine, Division of Rheumatology, UCSF; X. Li, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF, and Department of Biomedical Engineering, PAMI, Cleveland Clinic. [email protected].
³ From the Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, and the Department of Medicine, Division of Rheumatology, and the School of Pharmacy, at the University of California, San Francisco (UCSF), San Francisco, California; Department of Biomedical Engineering, Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
⁴ T. Shimizu, MD, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF, and Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University; A. Cruz, BS, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, and School of Pharmacy, UCSF; M. Tanaka, BS, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; K. Mamoto, MD, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF, and Department of Biomedical Engineering, PAMI, Cleveland Clinic; V. Pedoia, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; A.J. Burghardt, BS, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; U. Heilmeier, MD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; T.M. Link, MD, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF; J. Graf, MD, Department of Medicine, Division of Rheumatology, UCSF; J.B. Imboden, MD, Department of Medicine, Division of Rheumatology, UCSF; X. Li, PhD, Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF, and Department of Biomedical Engineering, PAMI, Cleveland Clinic.

PMID: 30770506
DOI: 10.3899/jrheum.180496

Abstract

Objective: To investigate the correlation between changes in radiological quantitative assessment with changes in clinical and functional assessment from baseline to 3 months in patients with rheumatoid arthritis (RA).

Methods: Twenty-eight patients with RA [methotrexate (MTX) and anti-tumor necrosis factor-α (TNF-α) group with high disease activity (n = 18); and MTX group with low disease activity (n = 10)] underwent assessments at baseline and 3 months: clinical [28-joint count Disease Activity Score (DAS28)], functional [Health Assessment Questionnaire (HAQ) and Michigan Hand Outcome Questionnaire (MHQ)], and imaging-based [3 Tesla magnetic resonance imaging (MRI) and high-resolution peripheral quantitative computed tomography (HR-pQCT)]. MR images were evaluated semiquantitatively [RA MRI scoring (RAMRIS)] and quantitatively for the volume of synovitis and bone marrow edema (BME) lesions. Erosion volumes were measured using HR-pQCT.

Results: After 3 months, the anti-TNF-α group demonstrated an improvement in disease activity through DAS28, HAQ, and MHQ. MRI showed significant decreases in synovitis and BME volume for the anti-TNF-α group, and significant increases in the MTX group. HR-pQCT showed significant decreases in bone erosion volume for the anti-TNF-α group, and significant increases in the MTX group. No significance was observed using RAMRIS. Changes in synovitis, BME, and erosion volumes, but not RAMRIS, were significantly correlated with changes in DAS28, HAQ, and MHQ.

Conclusion: Quantitative measures were more sensitive than semiquantitative grading when evaluating structural and inflammatory changes with treatment, and were associated with patient clinical and functional outcomes. Multimodality imaging with 3T MRI and HR-pQCT may provide promising biomarkers that help determine disease progression and therapy response.

Keywords: 3 TESLA MAGNETIC RESONANCE IMAGING; HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY; MULTIMODALITY IMAGING; QUANTITATIVE IMAGING MEASURES; RHEUMATOID ARTHRITIS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / diagnostic imaging*
Arthritis, Rheumatoid / drug therapy*
Arthritis, Rheumatoid / physiopathology
Biomarkers
Bone Marrow Diseases / diagnostic imaging
Edema / diagnostic imaging
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging / methods
Male
Methotrexate / therapeutic use*
Middle Aged
Surveys and Questionnaires
Synovitis / diagnostic imaging
Tomography, X-Ray Computed / methods
Treatment Outcome
Tumor Necrosis Factor Inhibitors / therapeutic use*
Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

Antirheumatic Agents
Biomarkers
Tumor Necrosis Factor Inhibitors
Tumor Necrosis Factor-alpha
Methotrexate