TY - JOUR

T1 - No overall damage progression despite persistent inflammation in adalimumab-treated psoriatic arthritis patients

T2 - results from an investigator-initiated 48-week comparative magnetic resonance imaging, computed tomography and radiography trial

AU - Poggenborg, René Panduro

AU - Wiell, Charlotte

AU - Bøyesen, Pernille

AU - Boonen, Annelies

AU - Bird, Paul

AU - Pedersen, Susanne Juhl

AU - Sørensen, Inge Juul

AU - Madsen, Ole Rintek

AU - Slot, Ole

AU - Møller, Jakob M

AU - Hasselquist, Maria

AU - Kubassova, Olga

AU - Østergaard, Mikkel

PY - 2014/4

Y1 - 2014/4

N2 - OBJECTIVE: In a comparative conventional MRI, dynamic contrast-enhanced (DCE)-MRI, CT and radiography study, the authors aimed to monitor whether inflammation is reduced or even eliminated and damage halted in PsA patients receiving anti-TNF therapy.METHODS: A 48-week prospective open-label investigator-initiated trial of 41 biologic-naive patients treated with 40 mg adalimumab every other week. Hand CT, MRI (according to the PsA MRI scoring system method) and radiography (Sharp-van der Heijde method) were obtained at weeks 0, 6 (only MRI), 24 and 48. Clinical response was assessed by the PsA Response Criteria (PsARC).RESULTS: In the 23 PsARC responders at week 48, significant decreases from baseline in MRI synovitis (mean -2.0, P < 0.05), bone marrow oedema (BMO) (-1.3, P < 0.05), flexor tenosynovitis (-2.1, P < 0.05) and total inflammation (-6.0, P < 0.005) were observed. However, MRI signs of inflammation remained present (week 48 total inflammation score median = 9). Several DCE-MRI parameters also decreased (P < 0.05) and were correlated (ρ = 0.62) with conventional MRI total inflammation score. No statistically significant changes in bone erosion or proliferation scores were observed. With CT as the standard reference for detecting bone erosions/proliferations, sensitivity, specificity and accuracy were 100%/40%, 83%/93% and 84%/86%, respectively, for MRI, whereas corresponding values for radiography were 17%/26%, 98%/96%, and 93%/87%, respectively. Erosive progression as assessed by CT was found in 6 of 480 joints and baseline BMO was predictive (relative risk 10, 95% CI 2.1, 49).CONCLUSION: MRI signs of inflammation decrease, but do not disappear, during anti-TNF-α therapy. No overall changes in bone erosions or proliferations were observed. On joint-level baseline MRI, BMO was related to subsequent erosive progression detected by CT.TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov/, NCT01465438.

AB - OBJECTIVE: In a comparative conventional MRI, dynamic contrast-enhanced (DCE)-MRI, CT and radiography study, the authors aimed to monitor whether inflammation is reduced or even eliminated and damage halted in PsA patients receiving anti-TNF therapy.METHODS: A 48-week prospective open-label investigator-initiated trial of 41 biologic-naive patients treated with 40 mg adalimumab every other week. Hand CT, MRI (according to the PsA MRI scoring system method) and radiography (Sharp-van der Heijde method) were obtained at weeks 0, 6 (only MRI), 24 and 48. Clinical response was assessed by the PsA Response Criteria (PsARC).RESULTS: In the 23 PsARC responders at week 48, significant decreases from baseline in MRI synovitis (mean -2.0, P < 0.05), bone marrow oedema (BMO) (-1.3, P < 0.05), flexor tenosynovitis (-2.1, P < 0.05) and total inflammation (-6.0, P < 0.005) were observed. However, MRI signs of inflammation remained present (week 48 total inflammation score median = 9). Several DCE-MRI parameters also decreased (P < 0.05) and were correlated (ρ = 0.62) with conventional MRI total inflammation score. No statistically significant changes in bone erosion or proliferation scores were observed. With CT as the standard reference for detecting bone erosions/proliferations, sensitivity, specificity and accuracy were 100%/40%, 83%/93% and 84%/86%, respectively, for MRI, whereas corresponding values for radiography were 17%/26%, 98%/96%, and 93%/87%, respectively. Erosive progression as assessed by CT was found in 6 of 480 joints and baseline BMO was predictive (relative risk 10, 95% CI 2.1, 49).CONCLUSION: MRI signs of inflammation decrease, but do not disappear, during anti-TNF-α therapy. No overall changes in bone erosions or proliferations were observed. On joint-level baseline MRI, BMO was related to subsequent erosive progression detected by CT.TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov/, NCT01465438.

KW - Adult

KW - Anti-Inflammatory Agents

KW - Antibodies, Monoclonal, Humanized

KW - Arthritis, Psoriatic

KW - Disease-Free Survival

KW - Female

KW - Hand Joints

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Synovitis

KW - Tomography, X-Ray Computed

KW - Treatment Outcome

U2 - 10.1093/rheumatology/ket426

DO - 10.1093/rheumatology/ket426

M3 - Journal article

C2 - 24369412

VL - 53

SP - 746

EP - 756

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 4

ER -