OP0069 INCLUSION OF PATIENT RESEARCH PARTNERS IN REMEDY – A RESEARCH CENTER FOR TREATMENT OF RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background

Active collaboration between patients and researchers in development and implementation of scientific projects is important to ensure a good match between patient’s preferences and the scientific focus in research, contribute to more patient-oriented health research agendas, enhance patient friendly design of research projects, and creating support for implementation (1). Such involvement is strongly advocated by EULAR and is often a prerequisite to receive funding for clinical research projects. At Diakonhjemmet Hospital in Norway, the division of rheumatology and research has for many years worked to involve patient research partners (PRPs) in research. A patient advisory board was established in 2007, led by a person (20% position) who herself has a rheumatic disease. In eight years from 2022, the division will receive funding from the Norwegian Research Council to establish and host a clinical research center for treatment of Rheumatic and Musculoskeletal diseases – the REMEDY center.

Objectives

To describe how involvement of PRPs are organised within the REMEDY center.

Methods

An organisation map was developed as part of the application for funding. The leader of the patient advisory board, together with three senior researchers, were involved in several rounds of discussions on how PRP involvement should be organised in the center, and also in meetings with the larger research group.

Results

The organisation of REMEDY is shown in Figure 1.

Figure 1.

Organisation of REMEDY.

1.All partners, including The Norwegian Rheumatism Association, (the largest patient organisastion in the field), are represented at the Center Board. This ensures patient involvement at the strategic level, including setting research agendas and priorities.

2.The center is led by a centre director and two co-directors, of which one has a specific responsibility of PRP-involvement

3.The Centre Executive Committee (CEC) consist of the Center Director and co-directors, the WP leaders, the leader of the patient advisory board, the key senior scientific staff members of the partner institutions involved in the center and senior staff members deemed appropriate by the Centre Director.

4.The patient advisory board, consisting of 10-15 PRPs, is central within the center. Members of the board will be involved in all research projects, collaborating with researchers to improve design, methodology, research outcomes and implementation. The board provides a platform for the members for education, development, and exchange of knowledge and experience.

5.There are seven work packages (WPs) in REMEDY, each approaching the knowledge needs within rheumatic and musculoskeletal diseases (RMDs) treatment from different angles, and with international collaborators. WP7 (Empowering the individual) will provide a platform for the Patient advisory board, facilitating input from PRPs to all WPs. The chair of the EULAR study group for collaborative research is an international collaborator in WP7.

The leader of the Patient Advisory board has a 50% position. Additionally, there is funding for board activities, and for PRP involvement in initial project phases, whereas PRP activities are included in applications for external funding.

Conclusion

The REMEDY center is organised to ensure involvement of PRPs at all organisational levels, from individual research trials to the strategic and operational management of the center.

References

[1]De Wit MP, Berlo SE, Aanerud GJ, Aletaha D, Bijlsma JW, Croucher L, et al. European League Against Rheumatism recommendations for the inclusion of patient representatives in scientific projects. Annals of the rheumatic diseases. 2011;70:722–26.

Disclosure of Interests

None declared.

OP0176 THE PERSISTENCE OF ANTI-SPIKE ANTIBODIES FOLLOWING TWO SARS-CoV-2 VACCINES IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES USING IMMUNOSUPPRESSIVE THERAPY, COMPARED TO HEALTHY CONTROLS

Background

Limited data is available regarding long-term effectiveness of SARS-CoV-2 vaccines in patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressive therapy. Whether the persistence of vaccine-induced humoral immunity against SARS-CoV-2 differs between this patient population and the general public is currently unknown.

Objectives

To compare the persistence of anti-Spike antibodies following two SARS-CoV-2 vaccine doses between IMID patients using immunosuppressive medication and healthy controls and identify predictors of antibody decline.

Methods

We included patients with inflammatory joint- and bowel diseases on immunosuppressive medication and healthy controls enrolled in the prospective observational Nor-vaC study. Serum samples were collected at two time points following two dose SARS-CoV-2 vaccination (first assessment within 6–48 days and second within 49–123 days). Sera were analysed for antibodies binding the receptor-binding domain (RBD) of the SARS-CoV-2 Spike protein. Anti-RBD <200 BAU /ml were defined as low levels. The estimated percent reduction in anti-RBD standardised to 30 days was calculated and factors associated with reduction were identified in multivariable regression models.

Results

A total of 1097 patients (400 rheumatoid arthritis, 189 psoriatic arthritis, 189 spondyloarthritis, 129 ulcerative colitis, 190 Crohn´s disease) (median age 54 years [IQR 43–64]; 56% women) and 133 controls (median age 45 years [IQR 35–56]; 83% women) provided blood samples within the defined intervals (median 19 days [IQR 15–24] and 97 days [86–105] after second vaccine dose). Antibody levels were significantly lower in patients compared to controls at both assessments, with median anti-RBD 1468 BAU/ml [IQR 500–5062] in patients and 5514 BAU/ml [2528–9580] in controls (p<0.0001) and 298 BAU/ml [IQR 79–500] in patients and 715 BAU/ml [28–2870] in controls (p<0.0001), at first and second assessment respectively. Figure 1 show antibody levels at both assessments after medication group. At the second assessment, anti-RBD antibody levels decreased below 200 BAU/ml in 452 (41%) patients and in 1 (0.8%) control (p<0.0001) (Table 1). The percentage change in anti-RBD levels were -86 % in patients and -77 % in controls (p<0.0001). The majority of patients using rituximab had low antibody levels at both assessments, Figure 1. In the multivariable regression analyses, patients had a greater decline in anti-RBD levels compared to controls β -3.7 (95% CI -6.0, -1.4) (p<0.001). Use of tumor necrosis factor inhibitors in mono- or combination therapy was associated with the greatest decline compared to controls, β -6.1 (95% CI -8.1, -4.1) and β -6.4 (-8.4, -4.2) respectively (p<0.001).

Table 1.

Serological response in patients and controls

Controls (n=133)Patients (n=1097)Anti-RBD antibodies (BAU/ml)1stassessment2ndassessment1stassessment2ndassessment<5, n (%)0018 (1.6)54 (5)5-19, n (%)004 (0.4)60 (5)20-199, n (%)01 (1)40 (4)338 (31)200-1999, n (%)25 (19)89 (67)548 (50)558 (51)2000-8999, n (%)71 (53)40 (30)398 (36)82 (7.5)≥ 9000, n (%)37 (28)3 (2)89 (8)5 (0.5)

1st assessment 6 - 48 days and 2nd assessment 49 -123 days after second vaccine dose. BAU= Binding antibody Units

Conclusion

Within four months after the second vaccine dose, anti-Spike antibody levels declined considerably in both IMID patients and controls. Patients had lower antibody levels at the first assessment and a more pronounced decline compared to controls, and were consequently more likely to have low antibody levels four months after the second vaccine dose. Our results support that IMID patients lose humoral protection and need additional vaccine doses sooner than healthy individuals.

Disclosure of Interests

Ingrid Egeland Christensen: None declared, Ingrid Jyssum: None declared, Anne Therese Tveter: None declared, Joe Sexton: None declared, Trung T. Tran: None declared, Siri Mjaaland: None declared, Grete B. Kro: None declared, Tore K. Kvien Speakers bureau: Amgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofi, Consultant of: Abbvie, Amgen, Biogen, Celltrion, Eli Lilly, Gilead, Mylan, Novartis, Pfizer, Sandoz, Sanofi, Grant/research support from: Grants to institution (Diakonhjemmet Hospital): Abbvie, Amgen, BMS, MSD, Novartis, Pfizer, UCB, David Worren: None declared, Jørgen Jahnsen Speakers bureau: AbbVie, Astro Pharma, Boerhinger Ingelheim, BMS, Celltrion, Ferring, Gilead, Hikma, Janssen Cilag, Meda, MSD, Napp Pharma, Novartis, Orion Pharma Pfizer, Pharmacosmos, Roche, Takeda, Sandoz, Consultant of: AbbVie, Boerhinger Ingelheim, BMS, Celltrion, Ferring, Gilead, Janssen Cilag MSD, Napp Pharma, Novartis, Orion Pharma, Pfizer, Pharmacosmos, Takeda, Sandoz, Unimedic Pharma, Grant/research support from: Abbvie, Pharmacosmos, Ferring, Ludvig A. Munthe Speakers bureau: Novartis, Cellgene, Espen Haavardsholm: None declared, John Torgils Vaage: None declared, Gunnveig Grodeland Speakers bureau: Bayer, Sanofi Pasteur, Thermo Fisher, Consultant of: Consulting fees from the Norwegian System of Compensation to Patients and AstraZeneca, Fridtjof Lund-Johansen: None declared, Kristin Kaasen Jørgensen Speakers bureau: Roche, BMS, Consultant of: Celltrion, Norgine, Silje Watterdal Syversen: None declared, Guro Løvik Goll Speakers bureau: AbbVie, Pfizer, UCB, Sandoz, Orion Pharma, Novartis, Consultant of: Pfizer, AbbVie, Sella Aarrestad Provan: None declared

POS1041 PREVALENCE, INCIDENCE AND ANTIRHEUMATIC DRUG USE IN PSORIATIC ARTHRITIS (PsA) IN NORWAY

Background:

Incidence estimates of PsA in Norway have varied from 6.9/100,000 person-years (pyrs) in Northern Norway to 41.3/100,000 pyrs in Central Norway, and point prevalence estimates have ranged from 1.3 to 6.9 per 1,000 adult inhabitants1,2, while nationwide epidemiologic data on PsA in Norway have been lacking.

Objectives:

To estimate prevalence, incidence and use of disease-modifying antirheumatic drugs (DMARDs) among PsA patients in Norway.

Methods:

The Norwegian Cardio-Rheuma register includes pseudonymized data from the total Norwegian population ≥18 years of age during 2008-2017, identified from the National Population register. Demographic and socioeconomic data were retrieved from Statistics Norway. Data on public or private somatic specialized care episodes were collected from the Norwegian Patient register (NPR) [ICD-10 codes for diagnoses and medical procedure codes for biologic DMARD infusions]. Information on dispensed DMARD prescriptions was captured from the Norwegian Prescription Database. Based on NPR data, PsA cases were defined as persons fulfilling three criteria: 1) 1st episode with ICD-10 code M07.0-M07.3 or L40.5 as main or contributory diagnosis (index date), 2) 2nd episode with code M07.0-M07.3 or L40.5 within 2-year period following index date, 3) an episode in internal medicine or rheumatology clinic with recorded M07.0-M07.3 or L40.5 within 2 years from index date. Years 2008-2010 served as a look-back period to identify prevalent PsA cases. To estimate pyrs at risk, we calculated number of individuals aged ≥ 18 years living in Norway on the 1st of January of each year 2011-2015 multiplied by one year (prevalent PsA cases excluded). Age- and sex-standardized incidence rates were calculated with 5-year age groups using the Norwegian adult population on January 1st 2015 as the standard.

Results:

During the look-back period 2008-2010, 7,697 cases fulfilled the PsA definition. In total, 6,183 incident PsA cases were identified during 2011-2015 (incidence 32/100,000 pyrs, 28 among men and 35 among women). Based on a sensitivity analysis comprising 5,065 PsA cases with no dispensed DMARD prescriptions ≥12 months before index date, incidence was slightly lower (26/100,000 pyrs). Patient characteristics and DMARD use are shown in Table 1. The incidence was highest among those aged 50-59 years in both sexes (Figure 1). PsA incidence was lower among those with higher education level (crude/age- and sex-standardized incidence per 100,000 pyrs for those below upper secondary education 34/38, upper secondary or post-secondary non-tertiary education 36/36, higher education 26/25). Point prevalence of PsA was 3.3/1,000 adult inhabitants on January 1st 2016.

Table 1.

Characteristics and treatment penetration of incident PsA patients 2011-2015

AllExcluding cases with DMARDs >1 yr prior to index dateN61835065Women, n (%)3442 (55.7)2783 (54.9)Age at index date, median (IQR)50.5 (40.7 - 59.8)49.9 (40.2 - 59.3)Use of DMARDs after index date, n (%)12 months24 months12 months24 months Any conventional DMARD3706 (59.9)4048 (65.4)2894 (57.1)3184 (62.9) Methotrexate3313 (53.6)3650 (59.0)2638 (52.1)2933 (57.9) Sulfasalazine440 (7.1)586 (9.5)330 (6.5)457 (9.0) Any biologic DMARD842 (13.6)1197 (19.4)485 (9.6)771 (15.2) TNF-inhibitors810 (13.1)1154 (18.7)477 (9.4)758 (15.0) Oral glucocorticoids1773 (28.7)2240 (36.2)1449 (28.6)1807 (35.7) Any DMARD or glucocorticoids4365 (70.6)4742 (76.7)3384 (66.8)3725 (73.5)

Conclusion:

Our estimate of PsA incidence and prevalence are in the mid-range compared to studies from smaller regions in Norway. Methotrexate was initiated for more than half of PsA cases within one year from index date, whereas 19% had used biologic DMARDs within two years.

References:

[1]Hoff M, Gulati A, Romundstad P et al. Prevalence and incidence rates of psoriatic arthritis in central Norway: data from the Nord-Trondelag health study. Ann Rheum Dis 2015;74:60-64.

[2]Nossent J & Gran J. Epidemiological and clinical characteristics of psoriatic arthritis in northern Norway. Scand J Rheumatol 2009; 8:251-5.

Acknowledgements:

This work has been supported by a research grant from FOREUM Foundation for Research in Rheumatology.

Disclosure of Interests:

Anne Kerola Speakers bureau: Boehringer-Ingelheim, Consultant of: Pfizer, Gilead and Boehringer-Ingelheim, Joseph Sexton: None declared, Silvia Rollefstad: None declared, Grunde Wibetoe: None declared, Cynthia S. Crowson: None declared, Espen Haavardsholm: None declared, Tore K. Kvien Speakers bureau: Amgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofi, Consultant of: AbbVie, Amgen, Biogen, Celltrion, Eli Lilly, Gilead, Mylan, Novartis, Pfizer, Sandoz, Sanofi, Grant/research support from: research funding to Diakonhjemmet Hospital from AbbVie, Amgen, BMS, MSD, Pfizer and UCB, Anne Grete Semb Speakers bureau: AbbVie, Bayer, Lilly, Novartis, Sanofi, Consultant of: Sanofi, Grant/research support from: Collaborative research support from Lilly, outside the submitted work.

AB0122 THE NORA PROJECT - PREDICTION OF THERAPY RESPONSE IN RHEUMATOID ARTHRITIS

Background:

Personalized medicine in Rheumatoid arthritis (RA) especially regarding therapy response is still in early stages. The Nordic RA (NORA) project is aiming to improve the prediction of therapy outcome by combining established serologic marker with new markers, genetic information and patient-derived data.

Objectives:

As an initial step in the project the aim was to select clinically characterized patient cohorts and evaluate if changes or patterns in serological markers could predict therapy response and/or disease progress.

Methods:

The ARCTIC (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen) study [1] was designed to compare two tight control treatment strategies for early Rheumatoid arthritis and was used as a first cohort. Plasma samples (n=1622) from 224 RA patients from the ARCTIC study were included and taken at baseline and 3, 4, 6, 8, 10, 12, 14, 16, 20, and 24 months from trial start, and analyzed for the presence of EliATM RF (IgM, IgA, IgG), anti-CCP (IgG, IgA) and anti-RA33 (IgM, IgA, IgG) autoantibodies, as well as Calprotectin using the EliA instrument platform (Phadia AB, Uppsala, Sweden). In addition, a custom-made multiplex chip (Thermo Fisher Scientific, Sweden) [2] was used for measurement of anti-IgG antibodies against RA-specific antigens (citrullinated, acetylated and carbamylated), and established CTD-markers (Connective Tissue Disease), e.g. Ro52/60 and dsDNA. The citrullinated peptides on the multiplex chip were both multiple as well as single citrullinated at different positions within the peptide sequence. Additionally, we included an ELISA to measure antibodies against native human collagen II [3].

Results:

The different single assays in the baseline samples varied between 7 – 80% positive test results, e.g. anti-CCP IgG 80%. For some patients we could see changes in levels for anti-CCP, RF and anti-RA33 in the follow up samples, which varied from negative to more than 3-10xULN (Upper Limit of Normal). For anti-CCP IgG we found 9 patients (4%), who changed from negative to positive (patient 1-5) or from positive to negative (patient 6-8), while patient 9 had a peak at visit 6 (=12 months) and declined afterwards (figure 1). In addition, the above mentioned 9 patients showed clear changes in signal strength for the markers included on the multiplex chip and followed a similar pattern as the anti-CCP IgG signal. Different antibody patterns against single citrullinated peptides were observed and number of ACPA-positive peptides correlated with IgG anti-CCP levels.

Figure 1.

Anti-CCP IgG value normalised to cutoff (blue line) for patient 1 to 9. The heatmap visualizes the change over time in anti-CCP IgG signal with dark blue showing negative results and orange/red showing results >5xULN.

Anti-Collagen II antibodies (anti-CII) were detected in 15% of the baseline samples and in most cases declined over time. Two patients showed low baseline anti-CII levels that increased in the follow up samples. The changes in serological markers and the different reactivity patterns could possibly correlate with clinical outcome and define subgroups of patients with different response to therapy.

Results could be repeated in RA patients from the NOR-VEAC [4] cohort. At baseline 73% of the 106 RA patients had a positive anti-CCP IgG result and 11 patients (10%) showed a significant change of anti-CCP IgG level over time.

Conclusion:

Different response patterns and changes in serological antibody levels over the first 24 months after RA diagnosis could possibly reveal subgroups of patients with different prognosis and response to treatment. Further evaluations in additional treatment cohorts and correlation with clinical data are ongoing.

References:

[1]Haavardsholm et al., BMJ 2016;354:i4205.

[2]Hansson et al. Arthritis Research & Therapy 2012, 14:R201.

[3]Manivel et al Ann Rheum Dis. 2017 Sep;76(9):1529-1536.

[4]Mjaavatten et al., Arthritis Research & Therapy 2009, 11:R146.

Acknowledgements:

The NORA project is a NordForsk funded project.

Disclosure of Interests:

Linda Mathsson-Alm Employee of: Employee of Thermo Fisher Scientific, Isabel Gehring Employee of: Employee of Thermo Fisher Scientific, Maryam Poorafshar Employee of: Employee of Thermo Fisher Scientific, Johan Rönnelid: None declared, Johan Askling Grant/research support from: Research grants from Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, mainly in the context of safety monitoring (ARTIS), Espen Haavardsholm: None declared, Hilde Berner Hammer: None declared

POS0029 INCIDENCE AND TREATMENT PENETRATION OF RHEUMATOID ARTHRITIS IN NORWAY – A NATIONWIDE REGISTER LINKAGE STUDY

Background:

Incidence of rheumatoid arthritis (RA) in Norway has not been evaluated in a nationwide setting.

Objectives:

To estimate the incidence of RA and real-life penetration of disease-modifying antirheumatic drug (DMARD) use in Norway.

Methods:

The Norwegian Cardio-Rheuma register comprises pseudonymized data from nationwide registries including the total Norwegian population ≥18 years during 2008-2017. Demographic and socioeconomic data were retrieved from the National Population Register and Statistics Norway. Data on public or private somatic specialized care episodes were collected from the Norwegian Patient register (NPR) (ICD-10 codes for diagnoses and medical procedure codes for biologic DMARD infusions). Dispensed DMARD prescriptions were captured from the Norwegian Prescription Database. RA cases were defined as persons with NPR records of all of the following: 1) 1st episode with ICD-10 code M05/M06 as main or contributory diagnosis (index date), 2) 2nd episode with code M05/M06 within 2-year period following index date, 3) M05/M06 recorded in an internal medicine or rheumatology department during the 2-year period. Years 2008-2010 served as a look-back period to identify prevalent RA cases. To estimate person-years (pyrs) at risk, we calculated number of persons aged ≥ 18 living in Norway on the 1st of January of each year 2011-2015 and multiplied it by one year (prevalent RA cases excluded). Standardized estimates were calculated with 5-year age groups using Norwegian adult population 1st of January 2015 as the standard.

Results:

Between 2011 and 2015, 9,493 persons fulfilled the RA definition (62.4% seropositive based on ICD-10 codes). Incidence rate was 49/100,000 pyrs (32 in men and 65 in women). A sensitivity analysis excluding cases who had dispensed DMARDs >12 months before index date yielded 8,125 RA cases (incidence 42/100,000 pyrs). Whereas absolute number of incident cases was highest among those aged 60-69 in both sexes, incidence was highest among those aged 70-79 (Figure 1). Both crude and age- and sex-standardized incidences were lower among persons with higher education level (crude/standardized incidence per 100,000 pyrs for those below upper secondary education 60/57; upper secondary or post-secondary non-tertiary education 53/52; higher education 36/39). Of incident cases, 94% received any DMARD treatment or glucocorticoids, 78% methotrexate, and 17% biologic DMARDs within 2 years after index date (Table 1).

Conclusion:

Contemporary register-based estimate of RA incidence in Norway is comparable to other Nordic countries.1,2 In line with treatment recommendations, methotrexate is the most commonly used DMARD in the initial treatment strategy in Norway. One in six patients used a biologic DMARD within 2 years from 1st recorded RA diagnosis.

References:

[1]Eriksson JK, Neovius M, Ernestam S et al. Incidence of rheumatoid arthritis in Sweden: a nationwide population-based assessment of incidence, its determinants, and treatment penetration. Arthritis Care Res 2013;65:870-878.

[2]Puolakka K, Kautiainen H, Pohjolainen T et al. Rheumatoid arthritis remains a threat to work productivity: a nationwide register-based incidence study from Finland. Scand J Rheumatol 2010;39:436-438.

Figure 1.Table 1.

Characteristics and treatment penetration of incident RA patients 2011-2015

AllExcluding cases with DMARDs >12 months before index dateN94938125Women, n (%)6339 (66.8)5379 (66.2)Age at index date, median (IQR)60.5 (48.5 - 70.5)60.8 (48.8 - 70.9)RF positive, n (%)5927 (62.4)5193 (63.9)Use of DMARDs after index date, n (%)12 months24 months12 months24 months Any conventional DMARD7797 (82.1)8023 (84.5)6682 (82.2)6855 (84.4) Methotrexate7133 (75.1)7402 (78.0)6228 (76.7)6436 (79.2) Sulfasalazine902 (9.5)1218 (12.8)745 (9.2)1034 (12.7) Any biologic DMARD1102 (11.6)1642 (17.3)754 (9.3)1219 (15.0) TNF-inhibitors1006 (10.6)1513 (15.9)690 (8.5)1130 (13.9) Oral glucocorticoids6524 (68.7)6974 (73.5)5858 (72.1)6199 (76.3) Any DMARD or glucocorticoids8789 (92.6)8957 (94.4)7498 (92.3)7639 (94.0)

Acknowledgements:

This work has been supported by a research grant from FOREUM Foundation for Research in Rheumatology.

Disclosure of Interests:

Anne Kerola Speakers bureau: Boehringer-Ingelheim, Consultant of: Pfizer, Gilead, Boehringer-Ingelheim, Joseph Sexton: None declared, Grunde Wibetoe: None declared, Silvia Rollefstad: None declared, Cynthia S. Crowson: None declared, Espen Haavardsholm: None declared, Tore K. Kvien Speakers bureau: Amgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofimgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofi, Consultant of: AbbVie, Amgen, Biogen, Celltrion, Eli Lilly, Gilead, Mylan, Novartis, Pfizer, Sandoz, Sanofi, Grant/research support from: research funding to Diakonhjemmet Hospital from AbbVie, Amgen, BMS, MSD, Pfizer and UCB, Anne Grete Semb Speakers bureau: AbbVie, Bayer, Lilly, Novartis, and Sanofi, Consultant of: Sanofi, Grant/research support from: collaborative research support from Lilly, outside the submitted work.

Update on the OMERACT Magnetic Resonance Imaging Task Force: Research and Future Directions

Magnetic resonance imaging (MRI) provides an important biomarker across a range of rheumatological diseases. At the Outcome Measures in Rheumatology (OMERACT) 11 meeting, the MRI task force continued its work of developing and improving the use of MRI outcomes for use in clinical trials. The breadth of pathology in the Rheumatoid Arthritis MRI Score has been strengthened with further work on the development of a joint space narrowing score, and a series of exercises presented at OMERACT 11 demonstrated good reliability and construct validity for this assessment. Understanding the importance of residual inflammation after RA treatment remains a major focus of the group’s work. Analyses were presented on defining the level of synovitis (using MRI scores of a single hand) that would predict absence of erosion progression. The development of the OMERACT Hand Osteoarthritis MRI score has continued with substantial work presented on its iterative development, including pathology definition, scaling, and subsequent reliability of the score. Optimizing the role of MRI as a robust biomarker and surrogate outcome remains a priority for this group.

The OMERACT-RAMRIS Rheumatoid Arthritis Magnetic Resonance Imaging Joint Space Narrowing Score: Intrareader and Interreader Reliability and Agreement with Computed Tomography and Conventional Radiography

Objective.

To test the intrareader and interreader reliability of assessment of joint space narrowing (JSN) in rheumatoid arthritis (RA) wrist and metacarpophalangeal (MCP) joints on magnetic resonance imaging (MRI) and computed tomography (CT) using the newly proposed OMERACT-RAMRIS JSN scoring method, and to compare JSN assessment on MRI, CT, and radiography.

Methods.

After calibration of readers, MRI and CT images of the wrist and second to fifth MCP joints from 14 patients with RA and 1 healthy control were assessed twice for JSN by 3 readers, blinded to clinical and imaging data. Radiographs were scored by the Sharp/van der Heijde method. Intraclass correlation coefficients (ICC) and smallest detectable differences (SDD) were calculated, and the performance of various simplified scores was investigated.

Results.

Both MRI and CT showed high intrareader (ICC ≥ 0.95) and interreader (ICC ≥ 0.94) reliability for total (wrist + MCP) assessment of JSN. Agreement was generally lower for MCP joints than for wrist joints, particularly for CT. Intrareader SDD for MCP/wrist/MCP + wrist were 1.2/6.1/6.4 JSN units for MRI, while 2.7/8.3/9.9 JSN units for CT. JSN on MRI and CT correlated moderately well with corresponding radiographic JSN scores (MCP 2–5: 0.49 and 0.56; wrist areas assessed by Sharp/van der Heijde: 0.80 and 0.95), and high ICC between scores on MRI and CT were demonstrated (MCP: 0.94; wrist: 0.92; MCP + wrist: 0.92).

Conclusion.

The OMERACT-RAMRIS MRI JSN scoring system showed high intrareader and interreader reliability, and high correlation with CT scores of JSN. The suggested JSN score may, after further validation in longitudinal studies, become a useful tool in RA clinical trials.

A multireader reliability study comparing conventional high-field magnetic resonance imaging with extremity low-field MRI in rheumatoid arthritis

The use of extremity low-field magnetic resonance imaging (E-MRI) is increasing, but relatively few data exist on its reproducibility and accuracy in comparison with high-field MRI, especially for multiple readers. The aim of this multireader exercise of rheumatoid arthritis wrist and metacarpophalangeal joints was to assess the intermachine (high vs low-field) agreement and to assess the interreader agreement on high and low-field images. Study findings suggested that E-MRI performs similarly to conventional high-field MRI regarding assessment of bone erosions. However, for synovitis and bone edema, considerable intermachine and interreader variability was found. Further studies are needed before recommendations on multireader E-MRI assessment of these pathologies can be given.

A multicenter reliability study of extremity-magnetic resonance imaging in the longitudinal evaluation of rheumatoid arthritis

There are limited data on the reliability of extremity magnetic resonance imaging (E-MRI) in the longitudinal evaluation of rheumatoid arthritis (RA). Our aim was to assess the interreader reliability of the OMERACT RA MRI score in the assessment of change in disease activity and bone erosion scores using 0.2 T E-MRI hand and wrist images from 2 timepoints, evaluated by 3 readers at different international centers. The intraclass correlation coefficients and smallest detectable difference results for the change scores were generally good for erosions and synovitis, but were not acceptable for bone edema. Overall, E-MRI demonstrated ability to detect change comparable to that reported for high-field MRI for erosion and synovitis.

The OMERACT Magnetic Resonance Imaging Inflammatory Arthritis Group - advances and priorities

This article updates the work and research priorities of the OMERACT working group on magnetic resonance imaging (MRI) in inflammatory arthritis, as presented to the OMERACT 8 meeting in Malta in May 2006. This work focused on testing the reliability of dedicated extremity MRI in rheumatoid arthritis and on the initial steps in the development of an MRI score for peripheral psoriatic arthritis.

The evidence for magnetic resonance imaging as an outcome measure in proof-of-concept rheumatoid arthritis studies

Magnetic resonance imaging (MRI) has now been used extensively in cross-sectional and observational studies as well as in controlled clinical trials to assess disease activity and joint damage in rheumatoid arthritis (RA). MRI measurements or scores for erosions, bone edema, and synovitis have been developed and validated by several groups. The OMERACT criteria require that outcome measures demonstrate adequate validity, discriminative power, and feasibility if they are to be useful in clinical trials. Specific performance targets for these criteria depend on the scientific, regulatory, logistical, and financial context of the study in question. We review the extent to which MRI assessments of joint erosion, bone edema, and synovitis fulfil these criteria, particularly as they relate to proof-of-concept RA clinical trials.

Magnetic resonance imaging in rheumatoid arthritis advances and research priorities

This article updates the work and results of the OMERACT MRI in RA Working Group as presented at the OMERACT 7 meeting in May 2004, focusing on the development of the EULAR-OMERACT rheumatoid arthritis magnetic resonance imaging reference image atlas, and on areas for future research.

The development of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas

Based on a previously developed rheumatoid arthritis MRI scoring system (OMERACT 2002 RAMRIS), the development team agreed which joints, MRI features, MRI sequences, and image planes would best illustrate the scoring system in an atlas. After collecting representative examples for all grades for each abnormality (synovitis, bone oedema, and bone erosion), the team met for a three day period to review the images and choose by consensus the most illustrative set for each feature, site, and grade. A predefined subset of images (for example, for erosion--all coronal slices through the bone) was extracted. These images were then re-read by the group at a different time point to confirm the scores originally assigned. Finally, all selected images were photographed and formatted by one centre and distributed to all readers for final approval.

The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint

This paper presents the wrist joint MR images of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Reference images for scoring synovitis, bone oedema, and bone erosions according to the OMERACT RA MRI scoring (RAMRIS) system are provided. All grades (0-3) of synovitis are illustrated in each of the three wrist joint areas defined in the scoring system--that is, the distal radioulnar joint, the radiocarpal joint, and the intercarpal-carpometacarpal joints. For reasons of feasibility, examples of bone abnormalities are limited to five selected bones: the radius, scaphoid, lunate, capitate, and a metacarpal base. In these bones, grades 0-3 of bone oedema are illustrated, and for bone erosion, grades 0-3 and examples of higher grades are presented. The presented reference images can be used to guide scoring of wrist joints according to the OMERACT RA MRI scoring system.