title: No overall damage progression despite persistent inflammation in adalimumab-treated psoriatic arthritis patients: results from an investigator-initiated 48-week comparative magnetic resonance imaging, computed tomography and radiography trial.
abstract: OBJECTIVE
  In a comparative conventional MRI, dynamic contrast-enhanced (DCE)-MRI, CT and radiography study, the authors aimed to monitor whether inflammation is reduced or even eliminated and damage halted in PsA patients receiving anti-TNF therapy.
  
  
  METHODS
  A 48-week prospective open-label investigator-initiated trial of 41 biologic-naive patients treated with 40 mg adalimumab every other week. Hand CT, MRI (according to the PsA MRI scoring system method) and radiography (Sharp-van der Heijde method) were obtained at weeks 0, 6 (only MRI), 24 and 48. Clinical response was assessed by the PsA Response Criteria (PsARC).
  
  
  RESULTS
  In the 23 PsARC responders at week 48, significant decreases from baseline in MRI synovitis (mean -2.0, P < 0.05), bone marrow oedema (BMO) (-1.3, P < 0.05), flexor tenosynovitis (-2.1, P < 0.05) and total inflammation (-6.0, P < 0.005) were observed. However, MRI signs of inflammation remained present (week 48 total inflammation score median = 9). Several DCE-MRI parameters also decreased (P < 0.05) and were correlated (ρ = 0.62) with conventional MRI total inflammation score. No statistically significant changes in bone erosion or proliferation scores were observed. With CT as the standard reference for detecting bone erosions/proliferations, sensitivity, specificity and accuracy were 100%/40%, 83%/93% and 84%/86%, respectively, for MRI, whereas corresponding values for radiography were 17%/26%, 98%/96%, and 93%/87%, respectively. Erosive progression as assessed by CT was found in 6 of 480 joints and baseline BMO was predictive (relative risk 10, 95% CI 2.1, 49).
  
  
  CONCLUSIONS
  MRI signs of inflammation decrease, but do not disappear, during anti-TNF-α therapy. No overall changes in bone erosions or proliferations were observed. On joint-level baseline MRI, BMO was related to subsequent erosive progression detected by CT.
  
  
  BACKGROUND
  ClinicalTrials.gov, http://clinicaltrials.gov/, NCT01465438.
authors.affiliation: Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Nordre Ringvej 57, 2600 Glostrup, Denmark. poggenborg@dadlnet.dk.
authors.forename: René Panduro
authors.initials: RP
authors.lastname: Poggenborg
authors.forename: Charlotte
authors.initials: C
authors.lastname: Wiell
authors.forename: Pernille
authors.initials: P
authors.lastname: Bøyesen
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
authors.forename: Paul
authors.initials: P
authors.lastname: Bird
authors.forename: Susanne Juhl
authors.initials: SJ
authors.lastname: Pedersen
authors.forename: Inge Juul
authors.initials: IJ
authors.lastname: Sørensen
authors.forename: Ole Rintek
authors.initials: OR
authors.lastname: Madsen
authors.forename: Ole
authors.initials: O
authors.lastname: Slot
authors.forename: Jakob M
authors.initials: JM
authors.lastname: Møller
authors.forename: Maria
authors.initials: M
authors.lastname: Hasselquist
authors.forename: Olga
authors.initials: O
authors.lastname: Kubassova
authors.forename: Mikkel
authors.initials: M
authors.lastname: Østergaard
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013585:Synovitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab
keywords: biologic therapy; computed tomography; magnetic resonance imaging; psoriatic arthritis; radiography