Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial

Merete L Hetland; Kristian Stengaard-Pedersen; Michael Peter Junker; Mikkel Østergaard; Bo Jannik Ejbjerg; Søren Jacobsen; Tine Lottenburger; Ib Hansen; Ulrik Tarp; Lis S Andersen; Anders Svendsen; Jens K Pedersen; Ulrik B Lauridsen; Torkell Ellingsen; Hanne Lindegaard; Jan Pødenphanth; Aage Vestergaard; Anne Grethe Jurik; Kim Hørslev-Petersen; CIMESTRA study Group

doi:10.1136/ard.2009.125534

Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial

Merete L Hetland, Kristian Stengaard-Pedersen, Michael Peter Junker, Mikkel Østergaard, Bo Jannik Ejbjerg, Søren Jacobsen, Tine Lottenburger, Ib Hansen, Ulrik Tarp, Lis S Andersen, Anders Svendsen, Jens K Pedersen, Ulrik B Lauridsen, Torkell Ellingsen, Hanne Lindegaard, Jan Pødenphanth, Aage Vestergaard, Anne Grethe Jurik, Kim Hørslev-Petersen, CIMESTRA study Group

160 Citations (Scopus)

Abstract

Objective: At 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome. Methods: 139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intraarticular betamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline. Results: At 5 years, TSS progression rate was <1 unit/ year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years. Conclusion: Early and strict synovitis suppressive treatment with MTX and intra-articular GC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	69
Issue number	10
Pages (from-to)	1789-95
Number of pages	7
ISSN	0003-4967
DOIs	https://doi.org/10.1136/ard.2009.125534
Publication status	Published - 1 Oct 2010

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Hetland, M. L., Stengaard-Pedersen, K., Junker, M. P., Østergaard, M., Ejbjerg, B. J., Jacobsen, S., Lottenburger, T., Hansen, I., Tarp, U., Andersen, L. S., Svendsen, A., Pedersen, J. K., Lauridsen, U. B., Ellingsen, T., Lindegaard, H., Pødenphanth, J., Vestergaard, A., Jurik, A. G., Hørslev-Petersen, K., & CIMESTRA study Group (2010). Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial. Annals of the Rheumatic Diseases, 69(10), 1789-95. https://doi.org/10.1136/ard.2009.125534

Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial. / Hetland, Merete L; Stengaard-Pedersen, Kristian; Junker, Michael Peter et al.

In: Annals of the Rheumatic Diseases, Vol. 69, No. 10, 01.10.2010, p. 1789-95.

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

Hetland, ML, Stengaard-Pedersen, K, Junker, MP, Østergaard, M, Ejbjerg, BJ, Jacobsen, S, Lottenburger, T, Hansen, I, Tarp, U, Andersen, LS, Svendsen, A, Pedersen, JK, Lauridsen, UB, Ellingsen, T, Lindegaard, H, Pødenphanth, J, Vestergaard, A, Jurik, AG, Hørslev-Petersen, K & CIMESTRA study Group 2010, 'Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial', Annals of the Rheumatic Diseases, vol. 69, no. 10, pp. 1789-95. https://doi.org/10.1136/ard.2009.125534

Hetland ML, Stengaard-Pedersen K, Junker MP, Østergaard M, Ejbjerg BJ, Jacobsen S et al. Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial. Annals of the Rheumatic Diseases. 2010 Oct 1;69(10):1789-95. doi: 10.1136/ard.2009.125534

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title = "Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial",

abstract = "Objective: At 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome. Methods: 139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intraarticular betamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline. Results: At 5 years, TSS progression rate was <1 unit/ year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years. Conclusion: Early and strict synovitis suppressive treatment with MTX and intra-articular GC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.",

author = "Hetland, {Merete L} and Kristian Stengaard-Pedersen and Junker, {Michael Peter} and Mikkel {\O}stergaard and Ejbjerg, {Bo Jannik} and S{\o}ren Jacobsen and Tine Lottenburger and Ib Hansen and Ulrik Tarp and Andersen, {Lis S} and Anders Svendsen and Pedersen, {Jens K} and Lauridsen, {Ulrik B} and Torkell Ellingsen and Hanne Lindegaard and Jan P{\o}denphanth and Aage Vestergaard and Jurik, {Anne Grethe} and Kim H{\o}rslev-Petersen and Mikkel {\O}stergaard",

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doi = "10.1136/ard.2009.125534",

language = "English",

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pages = "1789--95",

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TY - JOUR

T1 - Radiographic progression and remission rates in early rheumatoid arthritis - MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial

AU - Hetland, Merete L

AU - Stengaard-Pedersen, Kristian

AU - Junker, Michael Peter

AU - Østergaard, Mikkel

AU - Ejbjerg, Bo Jannik

AU - Jacobsen, Søren

AU - Lottenburger, Tine

AU - Hansen, Ib

AU - Tarp, Ulrik

AU - Andersen, Lis S

AU - Svendsen, Anders

AU - Pedersen, Jens K

AU - Lauridsen, Ulrik B

AU - Ellingsen, Torkell

AU - Lindegaard, Hanne

AU - Pødenphanth, Jan

AU - Vestergaard, Aage

AU - Jurik, Anne Grethe

AU - Hørslev-Petersen, Kim

AU - CIMESTRA study Group

PY - 2010/10/1

Y1 - 2010/10/1

N2 - Objective: At 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome. Methods: 139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intraarticular betamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline. Results: At 5 years, TSS progression rate was <1 unit/ year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years. Conclusion: Early and strict synovitis suppressive treatment with MTX and intra-articular GC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.

AB - Objective: At 5 years' follow-up of early (<6 months) rheumatoid arthritis patients to (1) investigate whether initial combination therapy with methotrexate (MTX) and ciclosporin (CSA) (n=80) is superior to initial monotherapy with MTX (n=80) with respect to prevention of radiographic progression, (2) investigate whether the favourable clinical and radiographic response reported at 2 years in the CIMESTRA trial can be maintained and (3) identify predictors of radiographic outcome. Methods: 139 patients completed 5 years' follow-up with maintained double-blinding and a strict synovitis suppressive treatment strategy with intraarticular betamethasone injections (intra-articular glucocorticosteroid (GC)) and escalation of disease-modifying anti-rheumatic drug treatment. Disease activity, total Sharp-van der Heijde Score (TSS) of hands, wrists and forefeet were assessed at baseline and after 3, 4 and 5 years. MRI of the wrist and anti-cyclic citrullinated peptide (anti-CCP) were assessed at baseline. Results: At 5 years, TSS progression rate was <1 unit/ year and 47% had not progressed radiographically since baseline. 78% were in Disease Activity Score remission, 56% in American College of Rheumatology remission and 17% withdrawn from treatment due to remission. There were no differences between initial treatment groups. MRI-bone marrow oedema, TSS and anti-CCP predicted radiographic progression at 5 years. Conclusion: Early and strict synovitis suppressive treatment with MTX and intra-articular GC lead to high remission rates and halting of erosive progression at 5 years. No additional effect of initial combination therapy with CSA was found. The results parallel those reported for tumour necrosis factor α antagonists. Baseline MRI-bone oedema, TSS and anti-CCP predicted radiographic progression.

U2 - 10.1136/ard.2009.125534

DO - 10.1136/ard.2009.125534

M3 - Journal article

SN - 0003-4967

VL - 69

SP - 1789

EP - 1795

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 10

ER -