No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study

Uffe Møller Døhn; Bo Ejbjerg; Annelies Boonen; Merete Lund Hetland; Michael Sejer Hansen; Lene Surland Knudsen; Annette Hansen; Ole Rintek Madsen; Maria Hasselquist; Jakob M Møller; Mikkel Østergaard

doi:10.1136/ard.2009.123729

No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study

Uffe Møller Døhn, Bo Ejbjerg, Annelies Boonen, Merete Lund Hetland, Michael Sejer Hansen, Lene Surland Knudsen, Annette Hansen, Ole Rintek Madsen, Maria Hasselquist, Jakob M Møller, Mikkel Østergaard

132 Citations (Scopus)

Abstract

Aim To monitor joint inflammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography.To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring. Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy. Results No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p>0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off.Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p<0.05), as did DAS28, HAQ and tender and swollen joint counts (p<0.001).Patients with progression on CT had higher baseline MRI bone oedema scores.The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and time-integrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann-Whitney; p<0.05).With CT as the reference method, sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively.Median intraobserver correlation coefficient was 0.95 (range 0.44-0.99). Conclusion During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased.Inflammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	70
Issue number	2
Pages (from-to)	252-8
Number of pages	7
ISSN	0003-4967
DOIs	https://doi.org/10.1136/ard.2009.123729 https://doi.org/10.1136/ard.2009.123729
Publication status	Published - 1 Feb 2011

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Døhn, U. M., Ejbjerg, B., Boonen, A., Hetland, M. L., Hansen, M. S., Knudsen, L. S., Hansen, A., Madsen, O. R., Hasselquist, M., Møller, J. M., & Østergaard, M. (2011). No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. Annals of the Rheumatic Diseases, 70(2), 252-8. https://doi.org/10.1136/ard.2009.123729, https://doi.org/10.1136/ard.2009.123729

No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. / Døhn, Uffe Møller; Ejbjerg, Bo; Boonen, Annelies et al.

In: Annals of the Rheumatic Diseases, Vol. 70, No. 2, 01.02.2011, p. 252-8.

Research output: Contribution to journal › Journal article › Research › peer-review

Døhn, UM, Ejbjerg, B, Boonen, A, Hetland, ML, Hansen, MS, Knudsen, LS, Hansen, A, Madsen, OR, Hasselquist, M, Møller, JM & Østergaard, M 2011, 'No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study', Annals of the Rheumatic Diseases, vol. 70, no. 2, pp. 252-8. https://doi.org/10.1136/ard.2009.123729, https://doi.org/10.1136/ard.2009.123729

Døhn UM, Ejbjerg B, Boonen A, Hetland ML, Hansen MS, Knudsen LS et al. No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. Annals of the Rheumatic Diseases. 2011 Feb 1;70(2):252-8. doi: 10.1136/ard.2009.123729, http://dx.doi.org/10.1136/ard.2009.123729

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title = "No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study",

abstract = "Aim To monitor joint inflammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography.To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring. Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy. Results No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p>0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off.Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p<0.05), as did DAS28, HAQ and tender and swollen joint counts (p<0.001).Patients with progression on CT had higher baseline MRI bone oedema scores.The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and time-integrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann-Whitney; p<0.05).With CT as the reference method, sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively.Median intraobserver correlation coefficient was 0.95 (range 0.44-0.99). Conclusion During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased.Inflammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.",

author = "D{\o}hn, {Uffe M{\o}ller} and Bo Ejbjerg and Annelies Boonen and Hetland, {Merete Lund} and Hansen, {Michael Sejer} and Knudsen, {Lene Surland} and Annette Hansen and Madsen, {Ole Rintek} and Maria Hasselquist and M{\o}ller, {Jakob M} and Mikkel {\O}stergaard",

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doi = "10.1136/ard.2009.123729",

language = "English",

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T1 - No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study

AU - Døhn, Uffe Møller

AU - Ejbjerg, Bo

AU - Boonen, Annelies

AU - Hetland, Merete Lund

AU - Hansen, Michael Sejer

AU - Knudsen, Lene Surland

AU - Hansen, Annette

AU - Madsen, Ole Rintek

AU - Hasselquist, Maria

AU - Møller, Jakob M

AU - Østergaard, Mikkel

PY - 2011/2/1

Y1 - 2011/2/1

N2 - Aim To monitor joint inflammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography.To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring. Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy. Results No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p>0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off.Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p<0.05), as did DAS28, HAQ and tender and swollen joint counts (p<0.001).Patients with progression on CT had higher baseline MRI bone oedema scores.The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and time-integrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann-Whitney; p<0.05).With CT as the reference method, sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively.Median intraobserver correlation coefficient was 0.95 (range 0.44-0.99). Conclusion During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased.Inflammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.

AB - Aim To monitor joint inflammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography.To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring. Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy. Results No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p>0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off.Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p<0.05), as did DAS28, HAQ and tender and swollen joint counts (p<0.001).Patients with progression on CT had higher baseline MRI bone oedema scores.The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and time-integrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann-Whitney; p<0.05).With CT as the reference method, sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively.Median intraobserver correlation coefficient was 0.95 (range 0.44-0.99). Conclusion During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased.Inflammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.

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DO - 10.1136/ard.2009.123729

M3 - Journal article

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SN - 0003-4967

VL - 70

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JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

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