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: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rheumatology, Copenhagen University Hospitals at Hvidovre and Glostrup, Hvidovre, Denmark. umd@dadlnet.dk
authors.forename: Uffe Møller
authors.initials: UM
authors.lastname: Døhn
authors.forename: Bo
authors.initials: B
authors.lastname: Ejbjerg
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
authors.forename: Merete Lund
authors.initials: ML
authors.lastname: Hetland
authors.forename: Michael Sejer
authors.initials: MS
authors.lastname: Hansen
authors.forename: Lene Surland
authors.initials: LS
authors.lastname: Knudsen
authors.forename: Annette
authors.initials: A
authors.lastname: Hansen
authors.forename: Ole Rintek
authors.initials: OR
authors.lastname: Madsen
authors.forename: Maria
authors.initials: M
authors.lastname: Hasselquist
authors.forename: Jakob M
authors.initials: JM
authors.lastname: Møller
authors.forename: Mikkel
authors.initials: M
authors.lastname: Ostergaard
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D013585:Synovitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014463:Ultrasonography
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D008727:Methotrexate