Effect of a treat-to-target strategy based on methotrexate and intra-articular betamethasone with or without additional cyclosporin on MRI-assessed synovitis, osteitis, tenosynovitis, bone erosion, and joint space narrowing in early rheumatoid arthritis: results from a 2-year randomized double-blind placebo-controlled trial (CIMESTRA)

TY - JOUR

T1 - Effect of a treat-to-target strategy based on methotrexate and intra-articular betamethasone with or without additional cyclosporin on MRI-assessed synovitis, osteitis, tenosynovitis, bone erosion, and joint space narrowing in early rheumatoid arthritis

T2 - results from a 2-year randomized double-blind placebo-controlled trial (CIMESTRA)

AU - Møller-Bisgaard, S

AU - Ejbjerg, B J

AU - Eshed, I

AU - Hørslev-Petersen, K

AU - Hetland, M L

AU - Jurik, A G

AU - Thomsen, H

AU - Torfing, T

AU - Stengaard-Pedersen, K

AU - Junker, P

AU - Krogh, N S

AU - Lottenburger, T

AU - Ellingsen, T

AU - Andersen, L S

AU - Skjødt, H

AU - Svendsen, A J

AU - Tarp, U

AU - Hansen, I T

AU - Pødenphant, J

AU - Pedersen, J K

AU - Lindegaard, H

AU - Hanson, L G

AU - Vestergaard, A

AU - Glinatsi, D

AU - Østergaard, M

PY - 2017/9/3

Y1 - 2017/9/3

N2 - Objectives: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients, and to investigate whether concomitant cyclosporin A (CyA) provides an additional effect. Method: In the 2-year randomized, double-blind, treat-to-target trial CIMESTRA, 160 patients with eRA (< 6 months) were randomized to MTX, intra-articular betamethasone and CyA, or placebo CyA. A total of 129 patients participated in the MRI substudy, and had contrast-enhanced MR images of the non-dominant hand at months 0, 6, 12, and 24. MR images were evaluated for osteitis, synovitis, tenosynovitis, bone erosion, and joint space narrowing (JSN), using validated scoring methods. Results: Significant reductions were seen at 6 months in all inflammatory parameters [synovitis, mean change –1.6 (p < 0.001, Wilcoxon), tenosynovitis, –3.5 (p < 0.001), and osteitis, –1.3 (p < 0.05)] and at 12/24 months in synovitis and tenosynovitis [–1.6/–2.2 and –3.6/–3.8, respectively; all p < 0.001]. MRI signs of inflammation were not fully eliminated, and increases in erosion and JSN scores were observed at 6 months [0.4 (p < 0.01)/0.1 (p < 0.05)], 12 months [0.8 (p < 0.001)/0.3 (p < 0.01)], and 24 months [1.0 (p < 0.001)/0.4 (p < 0.001)]. Clinical measures decreased significantly (p < 0.001) at all time points. There were no consistent statistically significant differences between treatment groups. Conclusions: In this eRA treat-to-target trial, MTX and intra-articular glucocorticoids markedly reduced, but did not eliminate, MRI osteitis, synovitis, and tenosynovitis. Accordingly, minimal but statistically significant increases in bone erosion and JSN were observed. No additional effect of CyA was demonstrated.

AB - Objectives: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients, and to investigate whether concomitant cyclosporin A (CyA) provides an additional effect. Method: In the 2-year randomized, double-blind, treat-to-target trial CIMESTRA, 160 patients with eRA (< 6 months) were randomized to MTX, intra-articular betamethasone and CyA, or placebo CyA. A total of 129 patients participated in the MRI substudy, and had contrast-enhanced MR images of the non-dominant hand at months 0, 6, 12, and 24. MR images were evaluated for osteitis, synovitis, tenosynovitis, bone erosion, and joint space narrowing (JSN), using validated scoring methods. Results: Significant reductions were seen at 6 months in all inflammatory parameters [synovitis, mean change –1.6 (p < 0.001, Wilcoxon), tenosynovitis, –3.5 (p < 0.001), and osteitis, –1.3 (p < 0.05)] and at 12/24 months in synovitis and tenosynovitis [–1.6/–2.2 and –3.6/–3.8, respectively; all p < 0.001]. MRI signs of inflammation were not fully eliminated, and increases in erosion and JSN scores were observed at 6 months [0.4 (p < 0.01)/0.1 (p < 0.05)], 12 months [0.8 (p < 0.001)/0.3 (p < 0.01)], and 24 months [1.0 (p < 0.001)/0.4 (p < 0.001)]. Clinical measures decreased significantly (p < 0.001) at all time points. There were no consistent statistically significant differences between treatment groups. Conclusions: In this eRA treat-to-target trial, MTX and intra-articular glucocorticoids markedly reduced, but did not eliminate, MRI osteitis, synovitis, and tenosynovitis. Accordingly, minimal but statistically significant increases in bone erosion and JSN were observed. No additional effect of CyA was demonstrated.

KW - Adult

KW - Aged

KW - Antirheumatic Agents

KW - Arthritis, Rheumatoid

KW - Betamethasone

KW - Bone Diseases

KW - Cyclosporine

KW - Double-Blind Method

KW - Drug Administration Routes

KW - Drug Delivery Systems

KW - Drug Monitoring

KW - Drug Therapy, Combination

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Methotrexate

KW - Middle Aged

KW - Patient Acuity

KW - Synovitis

KW - Tendinopathy

KW - Treatment Outcome

KW - Journal Article

KW - Randomized Controlled Trial

U2 - 10.1080/03009742.2016.1209550

DO - 10.1080/03009742.2016.1209550

M3 - Journal article

C2 - 27775461

SN - 0300-9742

VL - 46

SP - 335

EP - 345

JO - Scandinavian Journal of Rheumatology

JF - Scandinavian Journal of Rheumatology

IS - 5

ER -