TY - JOUR
T1 - No overall damage progression despite persistent inflammation in adalimumab-treated psoriatic arthritis patients: results from an investigator-initiated 48-week comparative magnetic resonance imaging, computed tomography and radiography trial
AU - Poggenborg, R.P.
AU - Wiell, C.
AU - Boyesen, P.
AU - Boonen, A.
AU - Bird, P.
AU - Pedersen, S.J.
AU - Sorensen, I.J.
AU - Madsen, O.R.
AU - Slot, O.
AU - Moller, J.M.
AU - Hasselquist, M.
AU - Kubasova, O.
AU - Ostergaard, M.
PY - 2014/4
Y1 - 2014/4
N2 - Methods. A 48-week prospective open-label investigator-initiated trial of 41 biologic-naive patients treated with 40 mg adalimumab every other week. Hand CT, MRI (according to the PsA MRI scoring system method) and radiography (Sharp-van der Heijde method) were obtained at weeks 0, 6 (only MRI), 24 and 48. Clinical response was assessed by the PsA Response Criteria (PsARC).Results. In the 23 PsARC responders at week 48, significant decreases from baseline in MRI synovitis (mean -2.0, P <0.05), bone marrow oedema (BMO) (-1.3, P <0.05), flexor tenosynovitis (-2.1, P <0.05) and total inflammation (-6.0, P <0.005) were observed. However, MRI signs of inflammation remained present (week 48 total inflammation score median = 9). Several DCE-MRI parameters also decreased (P <0.05) and were correlated ( = 0.62) with conventional MRI total inflammation score. No statistically significant changes in bone erosion or proliferation scores were observed. With CT as the standard reference for detecting bone erosions/proliferations, sensitivity, specificity and accuracy were 100%/40%, 83%/93% and 84%/86%, respectively, for MRI, whereas corresponding values for radiography were 17%/26%, 98%/96%, and 93%/87%, respectively. Erosive progression as assessed by CT was found in 6 of 480 joints and baseline BMO was predictive (relative risk 10, 95% CI 2.1, 49).Conclusion. MRI signs of inflammation decrease, but do not disappear, during anti-TNF-alpha therapy. No overall changes in bone erosions or proliferations were observed. On joint-level baseline MRI, BMO was related to subsequent erosive progression detected by CT.Trial registration: ClinicalTrials.gov, ext-link-type="uri" xlink:href="http://clinicaltrials.gov/" xmlns:xlink="http://www.w3.org/1999/xlink">http://clinicaltrials.gov/, NCT01465438.
AB - Methods. A 48-week prospective open-label investigator-initiated trial of 41 biologic-naive patients treated with 40 mg adalimumab every other week. Hand CT, MRI (according to the PsA MRI scoring system method) and radiography (Sharp-van der Heijde method) were obtained at weeks 0, 6 (only MRI), 24 and 48. Clinical response was assessed by the PsA Response Criteria (PsARC).Results. In the 23 PsARC responders at week 48, significant decreases from baseline in MRI synovitis (mean -2.0, P <0.05), bone marrow oedema (BMO) (-1.3, P <0.05), flexor tenosynovitis (-2.1, P <0.05) and total inflammation (-6.0, P <0.005) were observed. However, MRI signs of inflammation remained present (week 48 total inflammation score median = 9). Several DCE-MRI parameters also decreased (P <0.05) and were correlated ( = 0.62) with conventional MRI total inflammation score. No statistically significant changes in bone erosion or proliferation scores were observed. With CT as the standard reference for detecting bone erosions/proliferations, sensitivity, specificity and accuracy were 100%/40%, 83%/93% and 84%/86%, respectively, for MRI, whereas corresponding values for radiography were 17%/26%, 98%/96%, and 93%/87%, respectively. Erosive progression as assessed by CT was found in 6 of 480 joints and baseline BMO was predictive (relative risk 10, 95% CI 2.1, 49).Conclusion. MRI signs of inflammation decrease, but do not disappear, during anti-TNF-alpha therapy. No overall changes in bone erosions or proliferations were observed. On joint-level baseline MRI, BMO was related to subsequent erosive progression detected by CT.Trial registration: ClinicalTrials.gov, ext-link-type="uri" xlink:href="http://clinicaltrials.gov/" xmlns:xlink="http://www.w3.org/1999/xlink">http://clinicaltrials.gov/, NCT01465438.
KW - psoriatic arthritis
KW - magnetic resonance imaging
KW - computed tomography
KW - radiography
KW - biologic therapy
KW - BONE-MARROW EDEMA
KW - RHEUMATOID-ARTHRITIS
KW - MRI BONE
KW - SCORES
KW - EROSIONS
KW - RESPONSIVENESS
KW - RELIABILITY
KW - PSAMRIS
KW - PLACEBO
KW - JOINTS
U2 - 10.1093/rheumatology/ket426
DO - 10.1093/rheumatology/ket426
M3 - Article
C2 - 24369412
SN - 1462-0324
VL - 53
SP - 746
EP - 756
JO - Rheumatology
JF - Rheumatology
IS - 4
ER -