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No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study
  1. Uffe Møller Døhn1,
  2. Bo Ejbjerg1,
  3. Annelies Boonen2,
  4. Merete Lund Hetland1,3,
  5. Michael Sejer Hansen4,
  6. Lene Surland Knudsen4,
  7. Annette Hansen3,5,
  8. Ole Rintek Madsen4,
  9. Maria Hasselquist6,
  10. Jakob M Møller6,
  11. Mikkel Østergaard1
  1. 1Department of Rheumatology, Copenhagen University Hospitals at Hvidovre and Glostrup, Hvidovre, Denmark
  2. 2Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  3. 3The DANBIO registry, Copenhagen University Hospital at Hvidovre, Hvidovre, Denmark
  4. 4Department of Rheumatology, Copenhagen University Hospital at Gentofte, Herlev, Denmark
  5. 5Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Denmark
  6. 6Department of Diagnostic Radiology, Copenhagen University Hospital at Herlev, Herlev, Denmark
  1. Correspondence to Dr Uffe Møller Døhn, Department of Rheumatology, Copenhagen University Hospitals at Hvidovre and Glostrup, Kettegaard Allé 30, 2650 Hvidovre, Denmark; umd{at}dadlnet.dk

Abstract

Aim To monitor joint inflammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography. To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring.

Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy.

Results No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p>0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off. Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p<0.05), as did DAS28, HAQ and tender and swollen joint counts (p<0.001). Patients with progression on CT had higher baseline MRI bone oedema scores. The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and time-integrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann–Whitney; p<0.05). With CT as the reference method, sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively. Median intraobserver correlation coefficient was 0.95 (range 0.44–0.99).

Conclusion During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased. Inflammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.

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Footnotes

  • Funding Funding was provided by Abbott Denmark, the Danish Rheumatism Association and the Aase and Ejner Danielsen Foundation. Abbott Denmark had no influence on, or involvement in, the planning or design of the study, data collection, data analysis or manuscript preparation.

  • Competing interests MLH has received consulting fees, speaking fees or research grants from Abbott, Centocor, Roche, Schering-Plough, UCB-Nordic and Wyeth, and she has received grants from Abbott, Bristol-Myers Squibb, Roche, Schering-Plough, UCB-Nordic and Wyeth on behalf of DANBIO. MSH has received consulting fees, speaking fees and/or research grants from Bristol-Myers Squibb, Roche, Schering-Plough and Wyeth. AH has received consulting fees, speaking fees or research grants from Abbott and Schering-Plough. MØ has received consulting fees, speaking fees or research grants from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Genmab, Glaxo-Smith-Kline, Novo, Pfizer, Roche, Schering-Plough, UCB and Wyeth.

  • Ethics approval This study was conducted with the approval of the local ethics committee, Copenhagen, Denmark.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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