title: Effects of double filtration plasmapheresis, leflunomide, and methotrexate on inflammatory changes found through magnetic resonance imaging in early rheumatoid arthritis.
abstract: OBJECTIVE
  To evaluate the effects of double filtration plasmapheresis (DFPP) in combination with leflunomide and methotrexate (MTX) on magnetic resonance imaging (MRI)-detected inflammatory changes (synovitis and bone edema) in patients with early rheumatoid arthritis (RA) with high disease activity.
  
  
  METHODS
  Sixty RA patients with highly active disease of 6 months' to 3 years' duration were randomized to receive DFPP in combination with leflunomide and MTX (DFPP group), and leflunomide plus MTX (no-DFPP group). The primary endpoint was the improvement in MRI-detected synovitis from baseline over 6 months. Secondary endpoint variables included DAS28 remission and American College of Rheumatology (ACR) criteria responses for 6 consecutive months.
  
  
  RESULTS
  The study achieved significant improvement in synovitis and bone edema, with significantly lower synovitis and bone edema scores in the DFPP group compared with the no-DFPP group (p < 0.001). Synovitis scores in 48.39% of patients (15/31) in the DFPP group were 0 at Month 6. Bone edema scores in 32.26% of patients (10/31) in the DFPP group were 0 at Month 6. We observed significantly greater ACR20, ACR50, ACR70, and ACR90 responses and DAS28 remission rates in the DFPP group than in the no-DFPP group (p < 0.001). Sustained DAS28 remission and ACR90 response for at least 6 months were achieved in 100% of patients receiving DFPP therapy.
  
  
  CONCLUSIONS
  The combination of DFPP and disease-modifying antirheumatic drugs (DMARD) was superior to DMARD alone for reducing MRI-detected signs of synovitis and bone edema in patients with early highly active RA. DFPP therapy enabled rapid and more complete suppression of inflammation in patients with highly active RA. Nearly half the patients (48.39%) who had received DFPP therapy achieved both clinical remission and imaging remission, a state characterized as true remission.
authors.affiliation: Department of Rheumatology and Immunology, Traditional Chinese Medicine-Western Medicine Hospital of Cangzhou, Hebei, China. glxiaoxia@126.com
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Yu
authors.forename: Lixin
authors.initials: L
authors.lastname: Wang
authors.forename: Ping
authors.initials: P
authors.lastname: Xu
authors.forename: Weiwei
authors.initials: W
authors.lastname: Lu
authors.forename: Guobin
authors.initials: G
authors.lastname: Lan
authors.forename: Lifeng
authors.initials: L
authors.lastname: Ping
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Wang
authors.forename: Junge
authors.initials: J
authors.lastname: Tian
authors.forename: Junlan
authors.initials: J
authors.lastname: Liu
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D042241:Early Diagnosis; D005260:Female; D006304:Health Status; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use*; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D000077339:Leflunomide; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010956:Plasmapheresis / Q000379:methods*; D011788:Quality of Life; D020127:Recovery of Function
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide; D008727:Methotrexate