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MR images were analyzed semi-quantitatively (Rheumatoid Arthritis Magnetic Resonance Imaging Score [RAMRIS]) and quantitatively (synovial volume (cm<jats:sup>3<\/jats:sup>); synovial perfusion; bone marrow edema (BME) proportion [%]). Multivariate analyses and receiver operating curves were applied to find the best predictor of long-term structural damage.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>81 patients (61\u2009\u00b1\u200912 years, F\/M:67\/14) were studied. MRI-detected inflammatory parameters markedly improved from baseline to year-1 and slightly deteriorated from year-1 to year-8 (synovial volume:6.7 \u00b1 5.0\u21922.6 \u00b1 2.9\u21923.6 \u00b1 3.3 cm<jats:sup>3<\/jats:sup> (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01); BME proportion:13.1 \u00b1 9.3\u21927.4 \u00b1 5.0\u21929.2 \u00b1 9.7% [<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01]). Structural damage progressively deteriorated from baseline to year-8. Two long-term structural damage pattern groups were apparent, namely a \u201cnon-progressive structural damage pattern\u201d (62%, 50\/81) and a \u201cprogressive structural damage pattern\u201d (38%, 31\/81). Functional impairment was more frequent and more severe at year-8 in patients with progressive structural damage. MRI-detected bone erosion score better predicted (AUC\u2009=\u20090.81, CI: 0.71\u20130.91) year-8 structural damage than clinical (SDAI AUC\u2009=\u20090.61, CI: 0.48\u20130.74), serological (CRP AUC\u2009=\u20090.60, CI: 0.47\u20130.73), or radiographic (AUC\u2009=\u20090.59, CI: 0.45\u20130.72) assessment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In ERA patients, two distinct structural damage patterns are evident. Baseline bone erosion score is better than clinical, serological, or radiographic assessment at predicting long-term structural damage.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Questions<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>The value of MRI in predicting long-term structural damage in ERA patients is not clear.<\/jats:italic>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Findings<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>This study identified two distinct long-term structural damage progression patterns of ERA patients. MRI can better differentiate between these two groups at baseline than clinical, serological, or radiographic assessment.<\/jats:italic>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Clinical relevance<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>MRI examination should be performed in all ERA patients at baseline to determine their structural damage pattern. This will allow a better prediction of patient outcomes in the long-term.<\/jats:italic>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00330-025-11493-5","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T14:49:47Z","timestamp":1742309387000},"page":"5403-5417","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Early rheumatoid arthritis, two distinctive structural damage patterns revealed by MRI: an 8-year longitudinal study"],"prefix":"10.1007","volume":"35","author":[{"given":"Su","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5206-9382","authenticated-orcid":false,"given":"James Francis","family":"Griffith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chungwun","family":"Yiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C. 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Griffith.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Jason Leung kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"This study only involves human participants. This study was approved by the Clinical Research Ethics Committee of the Joint Chinese University of Hong Kong (CUHK) and New Territories East Cluster (NTEC) (Ref. No.: 2021.398). Participants gave informed consent to participate in the study before taking part.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Some of the baseline to 1-year follow-up results of this study patients were published previously. This prior study addressed changes at baseline and year-1 in 77 of the initial cohort of patients included in the current study. The current study expanded the baseline cohort with the recruitment of more patients and followed up this larger baseline cohort for 8 years. Xiao et al [] A section of this study on patients also overlaps with this published study. Fifty ERA patients were randomly selected at baseline and year -1 to develop a program to automatically segment the wrist bones and calculate BME proportion (%) and BME relative intensity. This program is used in the current study as a quantification method for BME. Yiu et al [].","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}