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Response of early active rheumatoid arthritis to tumor necrosis factor inhibitors: evaluation by magnetic resonance imaging

  • Original Article
  • Published:
Modern Rheumatology

Abstract

Inflammatory changes (synovitis and bone marrow edema) and destructive changes (bone erosion) were evaluated by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA), and their relations with disease activity were assessed during treatment with tumor necrosis factor (TNF) inhibitors. Ten patients with early active RA underwent MRI at 0 and 16 weeks of TNF-inhibitor treatment. The carpal bones of the dominant hand were evaluated by the outcome measures in rheumatology clinical trials MRI score for RA. After 16 weeks, the mean disease activity score (DAS 28) decreased significantly from 5.54 to 2.70, while the number of tender joints, number of swollen joints, and inflammatory parameters were also significantly improved. The mean synovitis and marrow edema scores determined by MRI showed a significant decrease from 6.1 to 2.2 and 12.8 to 6.2, respectively, while the annual bone-erosion progression score decreased from 12.6 to 2.0. Although synovitis persisted in some patients, imaging remission was achieved in two patients. In conclusion, TNF-inhibitor therapy achieved an early decrease of disease activity and MRI revealed amelioration of joint destruction. The MRI score for RA is useful for assessing the early response to TNF inhibitors.

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References

  1. Ostegaard M, Hansen M, Stoltenberg M, Jensen KE, Szkudlarek M, Pedersen-Zbinden B, et al. New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier. Arthritis Rheum. 2003;48:2128–31.

    Article  Google Scholar 

  2. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.

    Article  PubMed  CAS  Google Scholar 

  3. Sharp JT, Young DY, Bluhm GB, Brower AC, Corbett M, et al. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis? Arthritis Rheum. 1985;28:1326–35.

    Article  PubMed  CAS  Google Scholar 

  4. Plant MJ, Saklatvala J, Borg AA, Jones PW, Dawes PT. Measurement and prediction of radiological progression in early rheumatoid arthritis. J Rheumatol. 1994;21:1808–13.

    PubMed  CAS  Google Scholar 

  5. Ostergaard M, Edmonds J, McQeen F, Peterfy C, Lassere M, Ejbjerg B, et al. An introduction to the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis. 2005;64(Suppl 1):i3–i7.

    Article  PubMed  Google Scholar 

  6. Cohen J. Statistical power analysis for the behavioral sciences. 2nd edn. Hillsdale: Lawrence Erlbaum; 1988.

    Google Scholar 

  7. Koike R, Takeuchi T, Eguchi K, Miyasaka N. Update on the Japanese guidelines for the use of infliximab and etanercept in rheumatoid arthritis. Mod Rheumatol. 2007;17:451–8.

    Article  PubMed  CAS  Google Scholar 

  8. Revised guidelines for TNF inhibitor therapy (published in January 2008). Tokyo: Japan College of Rheumatology

  9. Smyth CJ. Therapy of rheumatoid arthritis. A pyramidal plan. Postgrad Med. 1972;51:31–9.

    PubMed  CAS  Google Scholar 

  10. Weinblat ME, Coblyn JS, Fox DA, Fraser PA, Holdsworth DE, Glass DN, et al. Efficacy of low-dose methotrexate in rheumatoid arthritis. N Engl J Med. 1985;312:818–22.

    Google Scholar 

  11. Williams HJ, Willkens RF, Samuelson CO Jr, Alarcon GA, Guttadauria M, Yarboro C, et al. Comparison of low-dose oral pulse methotrexate and placebo in the treatment of rheumatoid arthritis. Arthritis Rheum. 1985;28:721–30.

    Article  PubMed  CAS  Google Scholar 

  12. Weinblatt ME, Kremer JM, Bankhurst AD, Bulpitt K, Fleischmann RM, Fox RI, et al. A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med. 1999;340:253–9.

    Article  PubMed  CAS  Google Scholar 

  13. Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, et al. Infliximab (chimeric anti-tumour necrosis factor αmonoclonal antibody) versus placebo in rheumatoid arthritis receiving concomitant methotrexate: a randomized phase III trial. Lancet. 1999;354:1932–9.

    Article  PubMed  CAS  Google Scholar 

  14. Klareskog L, van der Heijde D, Jager JP, Gough A, Kalden J, Malaise M, et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blinded randomised controlled trial. Lancet. 2004;363:675–81.

    Article  PubMed  CAS  Google Scholar 

  15. St. Clair EW, van der Heijde DMFM, Smolen JF, Maini RN, Bathon JM, Emery P, et al. Combination of infliximab and methotrexate therapy for early rheumatoid arthritis. Arthritis Rheum. 2004;50:3432–43.

    Article  PubMed  CAS  Google Scholar 

  16. Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission. Arthritis Rheum. 2006;54:3761–73.

    Article  PubMed  CAS  Google Scholar 

  17. Gaylis NB, Needell SD, Rudensky D. Comparison of in-office magnetic resonance imaging versus conventional radiography in detecting changes in erosions after one year of infliximab therapy in patients with rheumatoid arthritis. Mod Rheumatol. 2007;17:273–8.

    Article  PubMed  CAS  Google Scholar 

  18. Bathon JM, Martin RW, Fleishmann RM, Tesser JR, Schiff MH, Keystone EC, et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med. 2000;343:1586–93.

    Article  PubMed  CAS  Google Scholar 

  19. Nell VPK, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology. 2004;43:906–14.

    Article  PubMed  CAS  Google Scholar 

  20. Schirmer C, Scheel AK, Althoff CE, Schink T, Eshed I, Lembcke A, et al. Diagnostic quality and scoring of synovitis, tenosynovitis and erosions in low-field MRI of patients with rheumatoid arthritis: a comparison with conventional MRI. Ann Rheum Dis. 2007;66:522–9.

    Article  PubMed  Google Scholar 

  21. Quinn MA, Conaghan PG, O’Connor PJ, Karim Z, Greenstein A, Brown A, et al. Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal. Results from a twelve-month randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52:27–35.

    Article  PubMed  CAS  Google Scholar 

  22. Martinez-Martinez MU, Cuevas-Orta E, Reyes-Vaca G, Baranda L, Gonzalez-Amaro R, and Abud-Mendoza. Magnetic resonance imaging in patients with rheumatoid arthritis with complete remission treated with disease-modifying antirheumatic drugs or anti-tumour necrosis factor α agents: Ann Rheum Dis 2007;66:134–5.

  23. Conaghan PG, McQeen FM, Peterfy CG, Lassere MND, Ejbjerg B, Bird P, et al. The evidence for magnetic resonance imaging as an outcome measure in proof-of-concept rheumatoid arthritis studies. J Rheumatol. 2005;32:2465–9.

    PubMed  Google Scholar 

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Conflict of interest statement

The authors certify that there are no conflicts of interest in relation to this manuscript.

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Authors and Affiliations

  1. The Hirose Clinic of Rheumatology, 2-14-7 Midori-chou, Tokorozawa, Saitama, 359-1111, Japan

    Wataru Hirose, Kenichiro Nishikawa & Masuko Hirose

  2. Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Toshihiro Nanki

  3. Department of Radiology, Jichi Medical University Hospital, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Hideharu Sugimoto

Authors
  1. Wataru Hirose
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  2. Kenichiro Nishikawa
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  3. Masuko Hirose
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  4. Toshihiro Nanki
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  5. Hideharu Sugimoto
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Correspondence to Wataru Hirose.

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Hirose, W., Nishikawa, K., Hirose, M. et al. Response of early active rheumatoid arthritis to tumor necrosis factor inhibitors: evaluation by magnetic resonance imaging. Mod Rheumatol 19, 20–26 (2009). https://doi.org/10.1007/s10165-008-0114-4

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  • DOI: https://doi.org/10.1007/s10165-008-0114-4

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