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Assessment of Inflammation and Damage in Rheumatoid Arthritis Patients with Methotrexate Inadequate Response Receiving Tocilizumab Using Low Field MRI

Samira Rostom, Bouchra Amine, Rachid Bahiri, Fadoua Allali, Redouane Abouqal and Najia Hajjaj-Hassouni

Objectives: The aim of the study was to monitor joint inflammation and destruction in rheumatoid arthritis (RA) patients receiving tocilizumab therapy using MRI and compare MRI findings with clinical, biological and radiographic data.

Methods: Inclusion criteria were patients aged between 18 and 65 years, fulfilling American College of Rheumatology 1987 criteria for RA. All patients had methotrexate inadequate response with no prior biologic exposure. All patients were evaluated clinically including disease activity score 28 (DAS28) and by low field dedicated MRI (dominant hand and wrist) at initiation of treatment with anti-IL 6 receptor antibody agents and after 6 months. The MRI images were scored using the Outcome Measures in Rheumatology Clinical Trials RAMRI score (OMERACT RAMRIS).

Results: Among 22 patients with RA included in the study; 19 were female. The mean age was 42years ±13.7. Tree patients were excluded from the study before 24 weeks because of serious side effects. The study population exhibited significant decreases in all measures of disease activity at 24 weeks. At 24 weeks, the median RAMRIS synovitis (p<0.0001) and bone edema (p=0.04) scores were significantly reduced while RAMRIS bone erosion score was unchanged. The baseline RAMRIS synovitis score was strongly correlated with delta RAMRIS edema at 24 weeks (r= - 0.46; p=0.04).

Conclusion: This study suggests a significant reduction in MRI pre-erosive lesions (synovitis and osteitis) using Tocilizumab in patients with RA with inadequate response to DMARDS. Prospective studies with long term follow-up and imaging as an outcome measure are needed.