REMISSION^PLUS eine Initiative zur Integration moderner Bildgebung in die rheumatologische Versorgung Rückblick, Einblick, Ausblick: Auswertung der Niederfeld-MRT Daten

Zusammenfassung

Bildgebende Verfahren nehmen heute bei der Diagnosestellung und Therapiekontrolle der Rheumatoiden Arthritis (RA) eine unverzichtbare Rolle ein. Die Initiative REMISSION^PLUS hat seit 2006 über 10 Jahre das Ziel verfolgt, moderne bildgebende Verfahren wie die Arthrosonografie und die Magnetresonanztomografie (MRT) in den klinischen Alltag des Rheumatologen zu implementieren. Neben Schulungen (über 3 000 Rheumatologen in über 200 Veranstaltungen) wurden zahlreiche Bildgebungs- Studien durchgeführt. Erstmals werden jetzt zusammenhängend alle Niederfeld-MRT Daten aus der Initiative vorgestellt. Die Ergebnisse dieser multizentrischen Studie zeigen, dass die Niederfeld-MRT für RA Patienten eine komfortable Untersuchungsmethode darstellt und für den Rheumatologen die Möglichkeit bietet, effektiv und sehr genau Therapieeffekte (DMARD, Biologika) zu kontrollieren. Die MRT-Daten korrelierten hierbei signifikant mit Klinik und Labor. Mit der Methode ist es ferner möglich bei RA-Patienten subklinische Arthritiszeichen zu detektieren, zum anderen konnte fortschreitende radiologische Progression (Erosivität), trotz klinischer Remission („silent progression") erkannt werden. Diese Ergebnisse sind konventionell radiologisch nicht zu gewinnen, sodass der Einsatz der MRT neue Einblicke in die Pathogenese und konsekutiv neue Informationen für das Management der RA liefert. Die Bewertung dieser Vorteile und der Benefit für den Patienten im klinischen Alltag muss in weiteren Studien untersucht und diskutiert werden.

Abstract

Imaging plays a vital role in the diagnosis and treatment control of rheumatoid arthritis (RA). Since 2006, the initiative REMISSION^PLUS has aimed to implement modern imaging tools like arthrosonography and magnetic resonance imaging (MRI) into the routine clinical practice of rheumatologists. In addition to training sessions (over 3 000 rheumatologists in over 200 sessions), numerous sonography and MRI studies have been conducted to assess the value of these techniques for treatment control in RA. The following study summarises the results of the low-field MRI-studies. The results of this multicenter study demonstrate that low-field MRI is a comfortable examination for RA patients and enables rheumatologists to effectively and very carefully monitor treatment outcomes (DMARDs, biologics). MRI data significantly correlate with clinical and laboratory parameters. In addition, this method allows clinicians to detect subclinical indicators for arthritis as well as advancing radiological progression despite clinical remission ("silent progression"). These findings cannot be obtained in conventional X-rays. The use of MRI thus provides new insights into the pathogenesis and will consecutively deliver new informations for RA management. The assessment of these advantages and the benefits for patients in daily clinical routine need to be further examined and discussed in future studies.

Schlüsselwörter

Bildgebung - MRT - Rheumatoide Arthritis

Key words

imaging - MRI - rheumatoid arthritis

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