Background Monitoring of RA activity is important in daily practice and clinical trials, in particular for subjects receiving biologics. As a result, new imaging tools and more objective biomarkers of synovial inflammation and joint destruction have been developed.
Objectives To evaluate role of imaging methods (joint MRI, US), biomarkers (calprotectin-CP and MMP-3) and RA activity parameters in achievement of ACR70 response after Etanercept (ETN) therapy
Methods 25 pts (mean age 49,4±13,7 yrs) with active RA despite stable doses of cDMARDs (DAS28 6,12±0,97) had received ETN 50 mg weekly sc for 24 weeks. RA duration was 6,38±5,9 yrs, 92% were women, 64%>RF+. Clinical and laboratory evaluation was done at weeks 0 and 25. US exam was performed before start of ETN treatment and after 6 month of ETN therapy by the same independent sonographer. 7-joint score (grade 0–3) included wrist, intercarpal, 2–3 MCP, 2–3 PIP joints of the clinically dominant hand and knee was used. MRI was done at baseline and after end of ETN treatment. Assessment of 2–5 MCP joints of the clinically dominant hand (0-no synovitis, 1–10-severity of synovitis) was done by the same independent radiologist.CP and MMP-3 serum levels (ELISA) were measured at the same time points. Changes of all parameters since baseline were assessed. Predictive factors of achievement ACR70 responce were explored.
Results All clinical, laboratory, MRI and US parameters of RA activity had significantly improved during ETN therapy (p<0,05).We detected statistically significant difference only in baseline MRI synovitis score between responders and non-responders according ACR70 (p=0,0074). (table 1)
We did not find any significant difference between groups in MeΔ at weeks 0–12 of ESR, CRP, CP and MMP-3, whereas MeΔ of SJC distinguished in ACR70 responders and non-responders (p=0,0494).
Conclusions 1. US and MRI synovitis sum scores decreased significantly in parallel with CP and MMP-3 serum levels and RA activity variables during ETN therapy. 2. Low baseline MRI synovitis sum score is more useful in comparison with baseline US, CP, MMP-3 and conventional RA activity factors as predictive tool of good responce in RA during anti-TNF therapy. 3. Decrease of ESR, CRP, CP and MMP-3 at week 12 had not impact on ACR70 response at week 25.
Disclosure of Interest None declared