Article Text

other Versions

PDF
Extended report
A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis: results from the OPERA randomised controlled trial
  1. Mette Bjørnedal Axelsen1,2,
  2. Iris Eshed3,
  3. Kim Hørslev-Petersen4,5,
  4. Kristian Stengaard-Pedersen6,
  5. Merete Lund Hetland1,2,7,
  6. Jakob Møller8,
  7. Peter Junker9,
  8. Jan Pødenphant10,11,
  9. Annette Schlemmer12,
  10. Torkell Ellingsen13,
  11. Palle Ahlquist14,
  12. Hanne Lindegaard9,
  13. Asta Linauskas15,
  14. Mette Yde Dam13,
  15. Ib Hansen16,
  16. Hans Christian Horn14,
  17. Christian Gytz Ammitzbøll6,
  18. Anette Jørgensen6,
  19. Sophine B Krintel1,
  20. Johnny Raun4,5,
  21. Niels S Krogh17,
  22. Julia Sidenius Johansen2,18,
  23. Mikkel Østergaard1,2,7,
  24. OPERA study group
  1. 1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Glostrup, Denmark
  2. 2Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
  3. 3Department of Radiology, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
  4. 4King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark
  5. 5South Jutland Hospital, Institute of Regional Health Services Research, University of Southern Denmark, Denmark
  6. 6Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  7. 7The DANBIO Registry, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Glostrup, Denmark
  8. 8Department of Radiology, Copenhagen University Hospital at Herlev, Copenhagen, Denmark
  9. 9Department of Rheumatology C, Odense University Hospital, University of Southern Denmark, Odense, Denmark
  10. 10Department of Rheumatology, Copenhagen University Hospital at Gentofte, Gentofte, Denmark
  11. 11Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  12. 12Department of Rheumatology, Aarhus University Hospital in Aalborg, Aalborg, Denmark
  13. 13Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
  14. 14Department of Medicine, Vejle Regional Hospital, Vejle, Denmark
  15. 15Department of Rheumatology, Vendsyssel Hospital, Hjørring, Denmark
  16. 16Department of Rheumatology, Viborg Regional Hospital, Viborg, Denmark
  17. 17Zitelabs Aps, Copenhagen, Denmark
  18. 18Department of Medicine and Oncology, Copenhagen University Hospital at Herlev, Herlev, Denmark
  1. Correspondence to Dr Mette Bjørndal Axelsen, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Nordre Ringvej 57, opgang 5, stuen, Glostrup DK-2600, Denmark; mbaxelsen{at}gmail.com

Abstract

Objectives To investigate whether a treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid injections suppresses MRI inflammation and halts structural damage progression in patients with early rheumatoid arthritis (ERA), and whether adalimumab provides an additional effect.

Methods In a double-blind, placebo-controlled trial, 85 disease-modifying antirheumatic drug-naïve patients with ERA were randomised to receive methotrexate, intra-articular glucocorticosteroid injections and placebo/adalimumab (43/42). Contrast-enhanced MRI of the right hand was performed at months 0, 6 and 12. Synovitis, osteitis, tenosynovitis, MRI bone erosion and joint space narrowing (JSN) were scored with validated methods. Dynamic contrast-enhanced MRI (DCE-MRI) was carried out in 14 patients.

Results Synovitis, osteitis and tenosynovitis scores decreased highly significantly (p<0.0001) during the 12-months’ follow-up, with mean change scores of −3.7 (median −3.0), −2.2 (−1) and −5.3 (−4.0), respectively. No overall change in MRI bone erosion and JSN scores was seen, with change scores of 0.1 (0) and 0.2 (0). The tenosynovitis score at month 6 was significantly lower in the adalimumab group, 1.3 (0), than in the placebo group, 3.9 (2), Mann–Whitney: p<0.035. Furthermore, the osteitis score decreased significantly during the 12-months’ follow-up in the adalimumab group, but not in the placebo group, Wilcoxon: p=0.001–0.002 and p=0.062–0.146. DCE-MRI parameters correlated closely with conventional MRI inflammatory parameters. Clinical measures decreased highly significantly during follow-up.

Conclusions A treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid in patients with ERA effectively decreased synovitis, osteitis and tenosynovitis and halted structural damage progression as judged by MRI. The findings suggest that addition of adalimumab is associated with further suppression of osteitis and tenosynovitis.

  • Rheumatoid Arthritis
  • Magnetic Resonance Imaging
  • Treatment

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.