title: Clinical outcome and imaging changes after intraarticular (IA) application of etanercept or methylprednisolone in rheumatoid arthritis: magnetic resonance imaging and ultrasound-Doppler show no effect of IA injections in the wrist after 4 weeks.
abstract: OBJECTIVE
  To assess the magnetic resonance imaging (MRI) and ultrasound (US) changes in the wrist of patients with rheumatoid arthritis (RA) 4 weeks after an US guided intraarticular (IA) injection.
  
  
  METHODS
  Contrast enhanced MRI and US-Doppler were performed at baseline and 4 weeks after IA injection of either 40 mg methylprednisolone (n = 12) or 25 mg etanercept (n = 13) in 25 patients with RA taking disease modifying antirheumatic drugs with a therapy-resistant wrist joint. All injections were US guided.
  
  
  RESULTS
  There was an improvement in swollen target joint score (p < 0.001), tender target joint score (p < 0.002), and physician visual analog scale score (p < 0.001) after 4 weeks. Baseline MRI synovitis score was mean 5.08 (range 3-9) and was unchanged at followup in the whole group (p = 0.52) and between treatment groups (p = 0.43). MRI edema score (mean 4.46, range 0-29) in the total group was unchanged after 4 weeks (p = 0.13), whereas MRI erosion score increased in the total group from baseline, 17.88 (range 7-40), to 4 weeks, 18.25 (range 7-40) (p < 0.001). Neither US-Doppler color fraction (0.07) nor Resistive Index (RI) (p = 0.36) changed from baseline to 4 week followup.
  
  
  CONCLUSIONS
  In contrast to the clinical evaluation, imaging measures of relevance for the estimation of inflammation, US-Doppler, US RI, MRI synovitis, and bone-marrow edema did not change 4 weeks after a single IA injection of either methylprednisolone or etanercept in the wrist. Within the same period, erosive progression in some patients suggested that joints with active disease may deteriorate within as little as 1 month, and that this development is not arrested by 1 injection. Given the small sample size of our study further studies are required to confirm our results.
authors.affiliation: The Parker Institute Frederiksberg Hospital, Copenhagen, Denmark;
authors.forename: Mikael
authors.initials: M
authors.lastname: Boesen
authors.forename: Lars
authors.initials: L
authors.lastname: Boesen
authors.forename: Karl Erik
authors.initials: KE
authors.lastname: Jensen
authors.forename: Marco Amedeo
authors.initials: MA
authors.lastname: Cimmino
authors.forename: Søren
authors.initials: S
authors.lastname: Torp-Pedersen
authors.forename: Lene
authors.initials: L
authors.lastname: Terslev
authors.forename: Merete
authors.initials: M
authors.lastname: Koenig
authors.forename: Bente
authors.initials: B
authors.lastname: Danneskiold-Samsøe
authors.forename: Henrik
authors.initials: H
authors.lastname: Røgind
authors.forename: Henning
authors.initials: H
authors.lastname: Bliddal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D004311:Double-Blind Method; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000187:drug effects* / Q000473:pathology
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept; D008775:Methylprednisolone