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Erosive progression is minimal, but erosion healing rare, in rheumatoid arthritis patients treated with adalimumab. A 1 year investigator-initiated follow-up study using high-resolution computed tomography as the primary outcome measure
  1. Uffe Møller Døhn (umd{at}dadlnet.dk)
  1. Department of Rheumatology, Copenhagen University Hospital at Hvidovre, Denmark
    1. Annelies Boonen
    1. Department of Internal Medicine, Division of Rheumatology, Maastricht University Hospital, Netherlands
      1. Merete Lund Hetland
      1. The DANBIO registry and the Department of Rheumatology, Copenhagen University Hospital, Hvidovre, Denmark
        1. Michael Sejer Hansen
        1. Department of Rheumatology, Copenhagen University Hospital at Herlev, Denmark
          1. Lene Surland Knudsen
          1. Department of Rheumatology, Copenhagen University Hospital at Herlev, Denmark
            1. Annette Hansen
            1. Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Denmark
              1. Ole Rintek Madsen
              1. Department of Rheumatology, Copenhagen University Hospital at Gentofte, Denmark
                1. Maria Hasselquist
                1. Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev, Denmark
                  1. Jakob M Møller
                  1. Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev, Denmark
                    1. Mikkel Østergaard
                    1. Departments of Rheumatology, Copenhagen University Hospitals at Hvidovre and Herlev, Denmark

                      Abstract

                      Objective: With computed tomography (CT) and radiography to investigate if repair of bone erosions, defined as regression of erosion scores, occurs during adalimumab-treatment of rheumatoid arthritis (RA) patients.

                      Methods: Fifty-two RA patients, naïve to biologics, with at least two low-grade radiographic erosions in the wrist or metacarpophalangeal (MCP) joints in the same (index) hand, initiated adalimumab 40 mg sc. eow. Thirty-five patients completed the study (median age 61 years (range 19-86), disease duration 8 years (0-36)). CT of index wrist and MCP2-5 and radiographs of hands and forefeet were obtained at baseline, 6 and 12 months. Images were evaluated blinded to chronology and clinical data, and assessed according to Sharp/van der Heijde (radiographs) and OMERACT RA MRI scoring (CT) methods.

                      Results: All investigated parameters of disease activity had decreased at 6 and 12 months (P<0.001). No significant change in any imaging parameters of joint destruction was observed at 6 and 12 months. High intrareader agreements were reached (mean intraobserver intraclass coefficients: 0.96 (CT) and 0.97 (radiography)). The number of patients with change scores exceeding the smallest detectable change (SDC) was comparable on CT and radiography, as were proportions of patients progressing/regressing. Decreased erosion scores at 12 months were registered in 1.6% and 1.8% of sites assessed on CT and radiography respectively.

                      Conclusion: Repair of erosions in adalimumab-treated RA patients is rare, but erosive regression, exceeding the SDC, on CT and radiography occurred. The very limited overall erosive progression supports that joint destruction is minimal during adalimumab treatment of RA patients.

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