Effects of treatment with etanercept (Enbrel, TNRF:Fc) on rheumatoid arthritis evaluated by Doppler ultrasonography.
OBJECTIVE
to estimate and visualise the efficacy of treatment with etanercept (Enbrel) in patients with rheumatoid arthritis (RA) using colour Doppler and spectral Doppler ultrasonography to determine the possible changes in synovial perfusion during a one year observation period.


METHODS
Eleven patients from the European multicentre trial of the efficacy and safety of etanercept were included in this study when transferred into the open label, long term safety, and efficacy study. Before a scheduled dosage increase to 50 mg/week they were examined clinically, serologically, and by ultrasonography using the colour Doppler pixels and the spectral Doppler resistance index (RI) as indicators of inflammation. The patients were re-examined at two weeks and at one year follow up


RESULTS
The clinical activity decreased significantly from baseline to week 2, but no significant changes were seen from baseline to one year. The number of coloured pixels in each region of interest decreased from baseline to week 2 with a median reduction of 60% (p=0.005). This effect on the perfusion in the synovium could not be found after one year of treatment. During the initial treatment we detected an increase in synovial RI by spectral Doppler. The median increase in peripheral resistance from baseline to week 2 as estimated by the mean RI was 22.6% (p=0.005). The increase in peripheral resistance was maintained to some extent after one year (mean RI increased by 18.8% p=0.074).


CONCLUSIONS
Ultrasonography seems to be a promising tool for the detection of treatment response using spectral Doppler and pixel estimation.
Terslev
L
L
The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, DK 2000 Frederiksberg, Denmark. lene.terslev@fh.hosp.dk
Torp-Pedersen
S
S
Qvistgaard
E
E
Kristoffersen
H
H
Røgind
H
H
Danneskiold-Samsøe
B
B
Bliddal
H
H
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000068800:Etanercept; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D018615:Ultrasonography, Doppler, Color; D014955:Wrist Joint / Q000000981:diagnostic imaging
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept