PT  - JOURNAL ARTICLE
AU  - Mette Bjørndal Axelsen
AU  - Iris Eshed
AU  - Kim Hørslev-Petersen
AU  - Kristian Stengaard-Pedersen
AU  - Merete Lund Hetland
AU  - Jakob Møller
AU  - Peter Junker
AU  - Jan Pødenphant
AU  - Annette Schlemmer
AU  - Torkell Ellingsen
AU  - Palle Ahlquist
AU  - Hanne Lindegaard
AU  - Asta Linauskas
AU  - Mette Yde Dam
AU  - Ib Hansen
AU  - Hans Christian Horn
AU  - Christian Gytz Ammitzbøll
AU  - Anette Jørgensen
AU  - Sophine B Krintel
AU  - Johnny Raun
AU  - Niels S Krogh
AU  - Julia Sidenius Johansen
AU  - Mikkel Østergaard
AU  - OPERA study group
TI  - 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
AID  - 10.1136/annrheumdis-2013-204537
DP  - 2015 May 01
TA  - Annals of the Rheumatic Diseases
PG  - 867--875
VI  - 74
IP  - 5
4099  - http://ard.bmj.com/content/74/5/867.short
4100  - http://ard.bmj.com/content/74/5/867.full
SO  - Ann Rheum Dis2015 May 01; 74
AB  - 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.