OP0149 An mri guided treat-to-target strategy in rheumatoid arthritis patients in clinical remission improved mri inflammation but not damage progression – results from the imagine-ra randomised controlled trial

Background Magnetic Resonance Imaging (MRI) bone marrow oedema (BME)/osteitis and MRI synovitis have been identified as predictors of structural damage progression in rheumatoid arthritis RA. 1 2 Targeting MRI remission may reduce inflammation and halt damage progression. Objectives To investigate whether a 2 year treat-to-target (T2T) strategy targeting MRI remission (defined as absence of BME) suppresses MRI-determined measures of disease activity and structural joint damage in RA patients in clinical remission. Methods In the two year investigator initiated, randomised, open label multicentre IMAGINE-RA study, 200 RA patients in clinical remission (defined as DAS28-CRP Results MRI outcomes of inflammation and damage at 24 months are presented in the table 1. The MRI T2T arm showed statistically significant reductions at 24 months in all inflammatory endpoints (osteitis, tenosynovitis and total inflammation score, p Conclusions An MRI T2T strategy, aiming to eliminate MRI BME, was more effective than a conventional T2T strategy in reducing MRI inflammation but not MRI damage progression. The reduced inflammatory load caused by the MRI T2T strategy may reduce long-term structural joint damage and improve patient-reported outcomes, but more than two years follow-up data are needed to clarify this. Clinicaltrials.gov Identifier: NCT01656278 Reference [1] Hetland, et al. Ann Rheum Dis2009;68(3). [2] Boyesen, et al. Ann Rheum Dis2011;70(3). Disclosure of Interest None declared