MedicalResearch.com Interview with:
Signe Møller-Bisgaard MD, PhD
Center for Rheumatology and Spine Diseases
Copenhagen Center for Arthritis Research
MedicalResearch.com: What is the background for this study?
Response: The background was that to avoid long-term consequences of rheumatoid arthritis (RA) such as progressive joint damage progression leading to functional impairment and loss of quality of life, it is essential for patients with RA to achieve clinical remission, which is a disease state with no clinical signs and symptoms of disease activity. But despite treating our patients according to current clinical recommendations using targeted treatment strategies, so that the patients reach a state of remission, joint damage progression still occurs in one out of four patients. We knew, that MRI inflammatory findings such as synovitis and bone marrow edema are present in patients in clinical remission and are of prognostic value. In particular bone marrow edema has shown to be a strong predictor of erosive joint damage progression.
In the IMAGINE-RA randomized clinical trial we therefore wanted to investigate if an MRI treat-to-target strategy targeting absence of bone marrow edema versus a conventional disease activity-guided treat-to-target strategy would improve clinical and radiographic outcome in rheumatoid arthritis patients in clinical remission.
MedicalResearch.com: What are the main findings?
Response: Two-hundred patients were randomized. After 24 months follow-up we could not demonstrate any difference in our primary endpoints: Compared to the conventional treat-to-target approach, this trial showed no benefit of using MRI to guide treatment for the primary outcomes of achieving disease activity remission and eliminating radiographic progression.
MedicalResearch.com: What should readers take away from your report?
Response: Based on the primary results of our study the routine use of an MRI-guided strategy for treating patients with rheumatoid arthritis cannot be recommended.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We are following up on the Imagine-RA cohort in the observational long-term follow-up study “IMAGINE-more”, in which we will examine the patients 3, 4, 5 and 10 years after inclusion in the IMAGINE-RA trial to investigate whether the 2-year MRI-guided treat-to-target strategy improves key outcomes in the long term. Further research is also needed to investigate potential predictors of joint destruction in this remission cohort. Finally, the scientific background for the surprising finding that we could not demonstrate an effect on halting erosive joint progression despite succeeding in achieving a significantly lower bone marrow edema score in the MRI-treat-to-target group.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is important to emphasize that this study does not show that MRI is useless for all purposes in rheumatoid arthritis. MRI is still an important tool for example for diagnosis or prognostication, and the findings in our study only demonstrates that elimination of subclinical bone marrow edema is not a recommendable goal for a treat-to-target approach in patients with RA.
We have no disclosures except for the ones mentioned in the paper.
Møller-Bisgaard S, Hørslev-Petersen K, Ejbjerg B, et al. Effect of Magnetic Resonance Imaging vs Conventional Treat-to-Target Strategies on Disease Activity Remission and Radiographic Progression in Rheumatoid Arthritis: The IMAGINE-RA Randomized Clinical Trial. JAMA. 2019;321(5):461–472. doi:10.1001/jama.2018.21362
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