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Posted by on Nov 25, 2019 in Rheumatoid Arthritis | 0 comments

In a nutshell

This study investigated if early changes in magnetic resonance imaging (MRI) can predict long-term response (LTR) to treatment in rheumatoid arthritis (RA). 

They found that MRI changes after 1 month of treatment can predict LTR to tofacitinib (Xeljanz).

Some background

Rheumatoid arthritis (RA) is caused by painful swelling in the joints. Inflammation causes tissue in the joints to degenerate over time. This can lead to significant disability and poor quality of life. The aim of RA treatment is to achieve low disease activity (LDA) or remission (no symptoms). Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat RA. 

Predicting long-term response (LTR) to a DMARD is important. It means that treatment can be optimized to slow disease progression. Studies show that the LTR to a DMARD can be predicted based on 1 to 3 months of treatment. Magnetic resonance imaging (MRI) is used to assess joint damage. MRI changes may be used to predict LTR. Tofacitinib (TFC) is a DMARD that targets Janus kinase (JAK) enzymes. This leads to reduced inflammation in the joints. It is unclear if early MRI changes can predict LTR to TFC.

Methods & findings

This study included 109 patients with RA. This was a secondary analysis of a study investigating the effectiveness of TFC. Patients were treated with TFC alone or in combination with methotrexate (MTX), another DMARD. MRIs were performed at 1, 3, 6 and 12 months. Disease progression was measured by comparing results to baseline MRI results. 

Lower disease progression scores at 1 and 3 months on the MRI were associated with slower disease progression at 12 months. Disease progression at 1 and 3 months predicted the LTR up to 12 months. These early MRI findings accurately predicted joint parameters including joint space narrowing. 

The bottom line

The authors concluded that MRI changes after 1 month of treatment can predict LTR to tofacitinib treatment in patients with RA.

The fine print

The number of patients in this study was low. It is still unclear if early MRI signs predict the LTR longer than 12 months. More studies are needed. 

Published By :

Arthritis Research & Therapy

Date :

Oct 21, 2019

Original Title :

Very early MRI responses to therapy as a predictor of later radiographic progression in early rheumatoid arthritis.

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