A treat-to-target strategy guided by magnetic resonance imaging (MRI) did not improve disease activity or reduce radiographic progression compared with a conventional treat-to-target strategy among patients with rheumatoid arthritis (RA) in clinical remission, according to data published in JAMA.

Researchers conducted a 2-year, randomized, multicenter trial (ClinicalTrials.gov identifier: NCT01656278) to determine whether an MRI-guided strategy improves outcomes among patients with RA in clinical remission. The study included 200 patients with RA with a 28-joint Disease Activity Score based on C-reactive protein (DA28-CRP) <3.2 and no swollen joints.

Participants were randomly assigned to receive an MRI-guided strategy or conventional treat-to-target strategy. The treatment goal for the MRI-guided group was the absence of MRI bone marrow edema combined with clinical remission, defined as DAS28-CRP <3.2 with no swollen joints, whereas the treatment goal for the conventional group was clinical remission. Primary outcomes included the proportion of patients who achieved DAS28-CRP <2.6 and the proportion of patients with no radiographic progression at 24 months. Researchers used 1-sided testing to determine the significance for the primary outcome.

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A total of 76 participants from the MRI-guided group and 95 participants from the conventional group completed the study. Of these, 85% of participants in the MRI-guided group achieved DAS28-CRP <2.6 compared with 88% of participants in the conventional care group (risk difference, −4.8%; 1-sided P =.19). Results also showed that 66% of participants in the MRI-guided group had no radiographic progression at 24 months compared with 62% in the conventional care group (risk difference, 4.7%; 1-sided P =.25).

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The researchers noted that 17% of participants in the MRI-guided group and 6% of participants in the conventional care group experienced adverse events.

“These findings do not support the use of an MRI-guided strategy for treating patients with RA,” the authors concluded.


Moller-Bisgaard S, Horslev-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 trialJAMA. 2019;321(5):461-472.