Predicting the Future: Prognostication in Rheumatoid Arthritis

EULAR 2022 (VIRTUAL)—When a patient is diagnosed with rheumatoid arthritis (RA), several questions often come to mind: How does this affect life activities? Will I develop joint deformities? What can I expect my future to look like? At the 2022 Congress of the European Alliance of Associations for Rheumatology (EULAR), an abstract session on the subject of prognosis and prediction in RA highlighted several fascinating research projects that help clinicians better understand how to respond to patients when they ask these questions.

Active Discordance

Rudresh Shukla, MD, clinical research fellow in rheumatology, Division of Musculoskeletal and Dermatological Sciences, University of Manchester, England, delivered the first talk, which was on the subject of discordance between certain disease activity scores and ultrasound findings in patients with RA. Dr. Shukla introduced the concept of active discordance, in which the Disease Activity Score 28 Erythrocyte Sedimentation Rate (DAS28ESR) score for a patient indicates active disease but synovitis is not found on power Doppler ultrasound, and remission discordance, in which the DAS28ESR score indicates disease remission but synovitis is seen on power Doppler.

Dr. Shukla et al. used data from the VERDERA trial (i.e., very early etanercept and methotrexate vs. methotrexate with delayed etanercept in RA) to analyze features related to active and remission discordance and concordance—the latter meaning that DAS28ESR and ultrasound findings are consistent and both show either disease activity or remission.¹

In an evaluation of the 120 patients in this study, several trends were noted. First, about one-third of patients transitioned from active concordance at baseline to active discordance early on with treatment. Second, a sizable number of patients continued to show active discordance despite disease-modifying treatment. Third, early treatment with etanercept, together with methotrexate, increased the probability of imaging and clinical remission, even as early as week 12. Finally, the presence of power Doppler tenosynovitis at baseline was a predictor of DAS28 remission with or without synovitis seen on power Doppler ultrasound.

Early treatment with etanercept, together with methotrexate, increases the probability of imaging & clinical remission even as early as week 12.

Tenosynovitis on MRI

Dr. den Hollander

In the second talk, Nikolet K. den Hollander, MD, PhD, research physician, Leiden University Medical Center, the Netherlands, discussed the value of magnetic resonance imaging (MRI) in detecting rheumatoid arthritis early on in patients with contemporary undifferentiated arthritis. For this study, contemporary undifferentiated arthritis was defined as a patient with features of rheumatoid arthritis who did not meet either the 1987 or 2010 ACR/EULAR classification criteria for RA.² Den Hollander et al. looked at undifferentiated arthritis patients in the Leiden early arthritis cohort from 2010 to 2020.