title: Response evaluation of musculoskeletal involvement in patients with deep morphea treated with methotrexate and prednisolone: a combined MRI and clinical approach.
abstract: OBJECTIVE
  The purpose of this article is to explore the role of MRI in monitoring musculoskeletal involvement in patients with morphea who are undergoing treatment with methotrexate and prednisolone.
  
  
  METHODS
  Twenty-two consecutive patients (six men and 16 women; median age, 52 years) with systemic scleroderma and deep morphea prospectively underwent whole-body MRI twice, before treatment (time 1) and during follow-up after 6-12 months (time 2). Images were evaluated for abnormal signal intensity or thickening of sub-cutaneous fatty tissue septa, muscular fasciae, intramuscular perifascial septa, muscle signal intensity, and articular or tendon sheath synovial abnormalities on STIR and gadolinium-enhanced scans. For clinical assessment, the localized scleroderma (morphea) severity index and a 0-6 pain score were applied.
  
  
  RESULTS
  From a clinical point of view, none of our patients had progression of the disease, 12 patients were responders (defined as an improvement of localized scleroderma severity index and pain score ≥ 50%), and 10 patients had stable disease. Among responders, the number of patients with subcutaneous septal thickening (time 1, n = 9; time 2, n = 2), fascial enhancement (time 1, n = 8; time 2, n = 3), and articular synovitis (time 1, n = 5; time 2, n = 1) decreased more than in the stable disease group (subcutaneous septal thickening: time 1, n = 9; time 2, n = 8; fascial enhancement: time 1, n = 5; time 2, n = 5; articular synovitis: time 1, n = 8; time 2, n = 6). Subcutaneous thickening, fascial thickening, and fascial enhancement were scored significantly lower at follow-up MRI in responders.
  
  
  CONCLUSIONS
  MRI findings were sensitive to changes in musculoskeletal manifestations in patients with deep morphea undergoing systemic treatment with methotrexate and prednisolone. Thus, MRI can be recommended as an additional tool for response monitoring.
authors.affiliation: Department of Dermatology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schanz
authors.forename: Jörg
authors.initials: J
authors.lastname: Henes
authors.forename: Anja
authors.initials: A
authors.lastname: Ulmer
authors.forename: Ina
authors.initials: I
authors.lastname: Kötter
authors.forename: Gerhard
authors.initials: G
authors.lastname: Fierlbeck
authors.forename: Claus Detlef
authors.initials: CD
authors.lastname: Claussen
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
mesh_terms: D000328:Adult; D003287:Contrast Media; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D019786:Gadolinium DTPA; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D012594:Scleroderma, Localized / Q000188:drug therapy* / Q000473:pathology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D003879:Dermatologic Agents; D005938:Glucocorticoids; D011239:Prednisolone; D019786:Gadolinium DTPA; D008727:Methotrexate