The Natural Sequence in Which Subclinical Inflamed Joint Tissues Subside or Progress to Rheumatoid Arthritis: A Study of Serial Magnetic Resonance Images (MRIs) in the TREAT EARLIER Trial
Authors' conclusion
We identified natural sequences of subclinical inflammation in different joint tissues, which deepens our understanding of clinical arthritis and RA development. During RA progression, increasing osteitis followed previous increases in tenosynovitis and synovitis. During pain resolution, tenosynovitis decreased first, followed by decreasing synovitis and osteitis.
Study context
- Population
- Patients with clinically suspect arthralgia (CSA) and subclinical joint inflammation from the placebo arm of the TREAT EARLIER trial185 serial MRIs
- Participants
- 21 vs 35
- Comparison
- Rheumatoid arthritis (RA) progressors vs patients with spontaneous resolution of pain
- RA progressorsn = 21
- Spontaneous resolution of painn = 35
- Primary endpoint
- Temporal order of changes in subclinical inflammation (synovitis, tenosynovitis, osteitis) on serial MRI
Methodological detailsserial MRIs, placebo arm, cross-lagged models
- Serial MRIs
- Placebo arm
- Cross-lagged models
Primary result
As reported in the abstract
Sequence of joint tissue inflammation on MRI
- RA progressors: increasing osteitis in final 4 months before RA diagnosis followed incremental tenosynovitis and synovitis changes during 1 year to 4 months before diagnosis
- P < 0.01
- Pain resolution: tenosynovitis decreasing in first 4 months after CSA onset preceded decreasing synovitis and osteitis during 4-12 months
- P = 0.02 and P < 0.01
Further findings
Osteitis in anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative RA progressors (subgroups)
- Osteitis increased just before RA development in both ACPA-positive and ACPA-negative patients
Original publication
The Natural Sequence in Which Subclinical Inflamed Joint Tissues Subside or Progress to Rheumatoid Arthritis: A Study of Serial MRIs in the TREAT EARLIER Trial. Arthritis Rheumatol. Published 11 July 2023. doi:10.
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