Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion (original) (raw)
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Annals of the Rheumatic Diseases, 2011
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. 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. 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). 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.
Annals of the Rheumatic Diseases, 2012
Background: Observational studies have suggested that rheumatoid arthritis (RA) patients who experience an inadequate response to anti-TNF respond more favourably to rituximab (RTX) than to an alternative anti-TNF. However, the relative effectiveness of these agents on long-term outcomes, in particular radiographic damage, remains unclear. Objective: To compare the effectiveness of RTX against anti-TNF agents in preventing joint damage in RA patients having experienced an inadequate response to at least one prior anti-TNF. Methods: We performed a prospective cohort study within the Swiss RA registry (SCQM) of patients with RA who discontinued at least one anti-TNF and subsequently received either RTX or an alternative anti-TNF. The primary outcome, progression of radiographic joint erosions (ERO) over time, and the secondary outcome, functional disability (HAQ), were analyzed using regression models for longitudinal data and adjusted for potential confounders. Results: Of the 371 patients included, 104 received RTX and 267 received an alternative anti-TNF. During the median follow-up period of 2.6 years, the rates of ERO progression were similar between patients on RTX and on alternative anti-TNF (p=0.67). The evolution of the HAQ score was statistically significantly better in the RTX group (p = 0.016), but the magnitude of the effect is probably not clinically relevant. Conclusion: This observational study suggests that RTX is as effective as alternative anti-TNF in preventing erosions in RA patients who have previously experienced an inadequate response to anti-TNF.
Seminars in arthritis and rheumatism, 2018
To investigate the efficacy of two tight-control treatment strategies aimed at simplified disease activity score [SDAI] remission (SDAI ≤ 3.3) compared to DAS28 remission (DAS28 < 2.6) on progression of bone erosions in early rheumatoid arthritis (ERA) patients using high-resolution peripheral quantitative computed tomography (HR-pQCT). This was an open-label study in which 80 early RA patients were randomized to receive 1-year of tight-control treatment. Group 1 (n = 37) aimed at SDAI ≤ 3.3 and group 2 (n = 43) aimed at DAS28-CRP < 2.6. The number and size of bone erosions, as well as the bone mineral density (BMD) surrounding bone erosion at the second metacarpophalangeal joint (MCP2), were measured at baseline and 12 months. After 12 months, images were analyzed in 63 patients. Changes in clinical parameters, number and size of bone erosions as well as the BMD surrounding bone erosion between the two treatment groups were similar. Therefore, a post-hoc analysis including al...
Arthritis care & research, 2016
Objective To compare the bone healing effects of denosumab and alendronate in female rheumatoid arthritis (RA) patients by high-resolution peripheral quantitative computed tomography (HR-pQCT). Methods This is a post-hoc analysis of a randomized-controlled trial (NCT01770106). 40 patients were randomized in a 1:1 ratio to receive either subcutaneous denosumab (60mg) once or oral alendronate (70mg) weekly for 6 months. The size of individual bone erosions and the presence and extent of erosion-associated sclerosis (marginal osteosclerosis) were measured in the second metacarpal head of the non-dominant hand at baseline, 3 and 6 months. Results 42 erosions were identified at baseline. After 6 months, the width, depth and volume of erosion significantly decreased in the denosumab group (-0.23mm, -0.16mm, -0.91mm(3) , respectively: all p<0.01), whereas these parameters significantly increased in the alendronate group (0.19mm, 0.32mm, 1.38mm(3) respectively, all p<0.01; between gro...
Annals of the Rheumatic Diseases, 2013
Introduction Interleukin-6 receptor (IL-6R) blockade improves the signs and symptoms of rheumatoid arthritis (RA) and retards bone damage. Whether IL-6R blockade allows repair of existing bone erosions is so far unclear. Methods This study examined bone erosions in the metacarpophalangeal joints of 20 patients receiving treatment with the IL-6R blocker tocilizumab using micro CT (μCT). The maximal width and depth of individual bone erosions was measured at baseline and after 1 year of treatment. Results 133 bone erosions were identifi ed at baseline with a mean (±SD) size of 2.23±1.26 mm and depth of 2.16±1.50 mm. Distribution analysis showed predominant involvement of the second compared with the third and fourth metacarpophalangeal joints, the metacarpal heads compared with the phalangeal bases and the radial quadrants compared with all other surfaces. Repair of bone erosions during tocilizumab treatment was confi ned to those lesions showing sclerosis at baseline and/or at follow-up and those with a width larger than 1.6 mm. The mean decrease in width of sclerosed erosions was thus 0.14±0.05 mm (p=0.0086) and 0.20±0.08 mm (p=0.019) for sclerosing lesions after 1 year of treatment. Conclusions Blockade of IL-6R by tocilizumab can induce limited repair in a subset of erosions, particularly in large lesions with sclerosis. Repair of erosions during tocilizumab treatment refl ects the favourable impact of IL-6R blockade on local bone remodelling in patients with RA.
Annals of the Rheumatic Diseases, 2007
Objectives: To investigate intramodality and intermodality agreements of CT and MRI erosion volumes in metacarpophalangeal (MCP) joints in rheumatoid arthritis (RA), and to compare the volumes with erosion scores for CT, MRI and radiography. Methods: In total, 17 patients with RA and four healthy controls underwent unilateral CT, MRI and radiography of second to fifth MCP joints in one hand. Erosion volumes (using OSIRIS software) and scores were determined from CT, MRI and radiography (scores only). Results: CT, MRI and radiography detected 77, 62 and 12 erosions, respectively. On CT, the mean erosion volume was 26 mm 3 (median 10; range 0 to 248) and 30 mm 3 (18; 1 to 163) on MRI. Total erosion volumes (per patient/control) were 97 mm 3 (29; 0 to 485) on CT and 90 mm 3 (46; 0 to 389) on MRI. For volumes, Spearman correlation coefficients were 0.96 to 0.99 (CT vs CT), 0.95 to 0.98 (MRI vs MRI) and 0.64 to 0.89 (CT vs MRI), all p,0.01. MRI erosion volumes correlated with the Outcome Measures in Rheumatology Clinical Trials/ Rheumatoid Arthritis Magnetic Resonance Imaging Score (OMERACT RAMRIS) erosion scores (0.91 to 0.99; p,0.01) and the Sharp/van der Heijde erosion score (0.49 to 0.63; p,0.01). Conclusion: Very high intramodality and high intermodality agreements of CT and MRI erosion volumes were found, encouraging further testing in longitudinal studies. A close correlation with CT and MRI erosion volumes supports the OMERACT RAMRIS erosion score as a valid measure of joint destruction in RA. Q uantitative assessment of bone erosion volumes with MRI has been attempted in wrists and metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA), 1 2 and is expected to be valuable in documenting changes in joint damage in longitudinal studies. A semiquantitative scoring system, the Outcome Measures in Rheumatology Clinical Trials/Rheumatoid Arthritis Magnetic Resonance Imaging Score (OMERACT RAMRIS) for assessing bone erosions, synovitis and bone oedema in hands and wrists of patients with RA has been developed. 3 However, neither determination of erosion volumes by MRI nor the OMERACT RAMRIS erosion score have been sufficiently validated against any external reference.
Reumatologia, 2005
Ultrasonography, magnetic resonance imaging and conventional radiography of bone erosions in rheumatoid arthritis-a comparative study Ultrasonografia, rezonans magnetyczny i klasyczne zdjêcie rentgenowskie w ocenie nad¿erek w reumatoidalnym zapaleniu stawów-badanie porównawcze A An nn na a C Ci ie ec ch ho om ms sk ka a 1 1 , , R Re en na at ta a A An nd dr ry ys si ia ak k 2 2 , , M Ma a³ ³g go or rz za at ta a S Se er ra af fi in n-K Kr ró ól l 3 3 , , W Wi it to ol ld d T T³ ³u us st to oc ch ho ow wi ic cz z 1 1 , , M Ma ag gd da al le en na a Z Za ag gr ro od dz zk ka a 4 4 , , L Le es sz ze ek k K Kr ró ól li ic ck ki i 2 2 , , W Wi ie es s³ ³a aw w J Ja ak ku ub bo ow ws sk ki i 3 3
The Journal of Rheumatology, 2011
Objective.To investigate by magnetic resonance imaging (MRI) which bones in wrists and metacarpophalangeal (MCP) joints most frequently show bone erosions, and which most frequently demonstrate erosive progression, in early and established rheumatoid arthritis (RA).Methods.MRI datasets from 258 RA patients [126 with early RA (disease duration < 6 months)] were analyzed, of whom 223, including 126 with early RA, had 1-year followup MRI. All patients had MRI of one wrist, whereas 86 patients had additional images of 2nd–5th MCP joints, and 46 patients additional images of the contralateral wrist. MRI were evaluated blinded by one reader, according to the OMERACT RA MRI scoring system (RAMRIS) for erosions, and presence/absence of erosions was noted in each bone, as was presence/absence of erosive progression.Results.The capitate, ulna, lunate, triquetrum, and scaphoid were the 5 bones with both most frequent baseline erosions and most frequently demonstrated erosive progression. No...