February 24, 2020
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Patient-reported flares in RA linked to inflammation found via MRI, ultrasound

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Patient-reported flares among individuals with rheumatoid arthritis are linked to inflammation detected through serial MRI and ultrasound, according to findings published in Arthritis Research & Therapy.

“There is limited evidence about the relation between patient-reported flare and inflammatory lesions on imaging,” Dorota Kuettel, MD, of the University Hospital of Southern Denmark, and colleagues wrote. “A cross-sectional study reported [ultrasound] tenosynovitis to be associated with the FLARE-RA questionnaire, which is designed to detect flares between clinical visits. There are no published data investigating a potential link between patient-reported flares and inflammation detected by MRI.”

To examine the pattern and longitudinal links between inflammatory lesions, as detected by serial MRI and ultrasound, and patient-reported flares among those with RA, Kuettel and colleagues studied patients at the Danish Hospital for Rheumatic Diseases. The researchers recruited 80 consecutive adults with RA in low disease activity status and no swollen joints. The cohort was followed for 1 year.

Participants were asked to contact the hospital in the event of patient-reported hand flare accompanied by at least one tender or swollen joint. The 29 participants who such hand flares had four extra visits within 4 months from flare onset. These visits included clinical examination and patient-reported outcomes, as well as an MRI and ultrasound of wrists and hands. The researchers then scored MRI synovitis, tenosynovitis and bone marrow edema, as well as ultrasound synovitis and tenosynovitis. Scores recorded at and following the flare were compared to baseline, with associations evaluated using linear mixed models for repeated measurements.

 
Patient-reported flares among individuals with RA are linked to inflammation detected through serial MRI and ultrasound, according to findings.
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According to the researchers, synovitis and tenosynovitis as detected by MRI and ultrasound increased significantly at flare onset. Both synovitis ultrasound-detected tenosynovitis diminished quickly. Bone marrow edema demonstrated delayed increase yet persisted, as did MRI tenosynovitis, once the patient-reported flare had resolved.

In the researchers’ univariate models, patient-reported flares were associated with all MRI and ultrasound inflammatory markers, except for bone marrow edema, which was associated only with SJC28 and long-lasting flares lasting more than 14days. The researchers also found independent associations between patient-reported flares and tenosynovitis as detected by MRI and ultrasound (P<.05).

“The clinical signature of patient-reported flares aligned with imaging-defined inflammation on MRI and [ultrasound] of the hands,” Kuettel and colleagues wrote. “Patient-reported flares were associated with imaging biomarkers of pathophysiological manifestations of RA, i.e., inflammation in the synovium and tenosynovium, and in case of long-lasting flares, also in the bone marrow. We observed a differential sequence of tissue inflammation in relation to flare dynamics. Synovitis on MRI and [ultrasound] as well as tenosynovitis on US appeared early at flare onset but were short-lived.”

“By contrast, [bone marrow edema] evolved with delay and persisted after the flare had resolved, while MRI tenosynovitis increased rapidly and remained elevated for months,” they added. “Our findings indicate that patient-reported flares reflect the inflammatory burden of a relapse, which calls for a re-appraisal of patient-reported inflammation to drive the management of patients with RA.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.