title: Does ultrasound-scored synovitis depend on the pharmacokinetics of subcutaneous anti-TNF agents in patients with rheumatoid arthritis?
abstract: OBJECTIVE
  The aim of this study was to investigate the influence of the pharmacokinetics of s.c. anti-TNF agents on the grade of US-detected synovitis in RA patients.
  
  
  METHODS
  Fifty RA patients were prospectively recruited from the Biologic Therapy Unit of our hospital. Inclusion criteria were being in treatment with s.c. anti-TNF agents and having had neither changes in therapy nor local corticosteroid injections in the previous 3 months. Patients underwent clinical, laboratory [28-joint DAS (DAS28) and Simplified Disease Activity Index (SDAI)] and US assessment at two time points, i.e. at peak plasma drug concentration and at trough plasma drug concentration. US assessments were performed blindly to the anti-TNF agent, the administration time and the clinical and laboratory data. Twenty-eight joints were investigated for the presence and grade (0-3) of B-mode synovitis and synovial power Doppler signal. Global indices for B-mode synovitis (BSI) and Doppler synovitis (DSI) were calculated for 12 joints and for wrist-hand-ankle-foot joints. B-mode US remission was defined as a BSI <1 and Doppler US remission as a DSI <1.
  
  
  RESULTS
  There were no significant differences between the clinical, laboratory and B-mode and Doppler US parameters at peak time and trough time (P = 0.132-0.986). There were no significant differences between the proportion of patients with active disease and those in remission according to DAS28, SDAI, B-mode US and Doppler US at peak time and trough time assessments (P = 0.070-1).
  
  
  CONCLUSIONS
  Our results suggested that s.c. anti-TNF pharmacokinetics do not significantly influence US-scored synovitis in RA patients.
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain. enaredo@ser.es.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hinojosa
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: Valor
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Hernández-Flórez
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Mata-Martínez
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Serrano-Benavente
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Tamara
authors.initials: T
authors.lastname: Del Río
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Bello
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Montoro
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Nieto-González
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: González
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: López-Longo
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Indalecio
authors.initials: I
authors.lastname: Monteagudo
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Carreño
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000493:pharmacokinetics*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D018608:Ultrasonography, Doppler; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Doppler; pharmacokinetics; rheumatoid arthritis; synovitis; ultrasound