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Objective  High magnetic resonance imaging ( MRI )–detected inflammation is associated with greater progression and poorer outcomes in rheumatoid arthritis ( RA ). This analysis aimed to determine if baseline  MRI  inflammation was related to clinical response and remission in the Assessing Very Early Rheumatoid arthritis Treatment ( AVERT ) study.    Methods   AVERT  was a phase  III b, randomized, controlled trial with a 12‐month, double‐blind treatment period enrolling patients with early (≤2 years' duration), anti‐citrullinated peptide–positive methotrexate ( MTX )‐naive  RA . In this post hoc analysis, patients in the abatacept plus  MTX  (n = 114) and  MTX  (n = 111) arms with available  MRI  results were stratified into low and high baseline  MRI  inflammation groups based on previously developed cutoffs of synovitis and osteitis on unilateral hand–wrist contrast‐enhanced  MRI . Simplified Disease Activity Index ( SDAI ) remission (≤3.3), Clinical Disease Activity Index ( CDAI ) remission (≤2.8), Boolean remission, and Disease Activity Score in 28 joints using the C‐reactive protein level (<2.6) were assessed.    Results  Overall, 100 of 225 patients (44.4%) had high baseline  MRI  inflammation. In patients with high baseline  MRI  inflammation, a significantly greater proportion achieved remission at 12 months with abatacept plus  MTX  versus  MTX  across  SDAI  (45.1% versus 16.3%;  P  = 0.0022),  CDAI  (47.1% versus 20.4%;  P  = 0.0065), and Boolean indices (39.2% versus 16.3%;  P  = 0.0156). In patients with low baseline  MRI  inflammation, remission rates were not significantly different with abatacept plus  MTX  versus  MTX  ( SDAI : 39.7% versus 32.3%;  P  = 0.4961).    Conclusion  In seropositive,  MTX ‐naive patients with early  RA  and presence of objectively measured high inflammation by  MRI , indicating poor prognosis, remission rates were higher with abatacept plus  MTX  treatment versus  MTX .

Baseline Objective Inflammation by Magnetic Resonance Imaging as a Predictor of Therapeutic Benefit in Early Rheumatoid Arthritis With Poor Prognosis