title: Relationship Between Lymph Node Volume and Pain Following Certolizumab Therapy for Rheumatoid Arthritis Flare: A Pilot Study.
abstract: OBJECTIVE
  The mechanisms that trigger flare in rheumatoid arthritis (RA) are unknown. In murine arthritis models, dysfunctional lymph node (LN) drainage is associated with joint flare. To examine if LN alterations are associated with RA flare, we analyzed the change in LN volume via contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with active joint flare at baseline and 16 weeks after certolizumab pegol (CZP) therapy. We also assessed the changes in popliteal or epitrochlear LN volumes versus the Rheumatoid and Arthritis Outcome Score (RAOS) (knee), or the Michigan Hand Questionnaire (MHQ; wrist/hand), and Disease Activity Score 28 (DAS28), at baseline and 16 weeks.
  
  
  RESULTS
  Total LN volume in 7 of 10 patients with measurable LN on CE-MRI significantly decreased 16 weeks after CZP therapy (mean decrease 37%;P= 0.0019). Improvement in knee pain measured by the RAOS (P= 0.03) inversely correlated with a decrease in total popliteal LN volume (R2= 0.94). All patients demonstrated significant improvement in DAS28 (mean decrease 1.48;P= 0.0002). For flare in the hand, significant improvement in activities of daily living (ADL) as measured by the MHQ was observed (left hand mean improvement 20%;P= 0.02; right hand mean improvement 37%;P= 0.03).
  
  
  CONCLUSIONS
  RA patients with the smallest change in LN volume during anti-tumor necrosis factor (anti-TNF) therapy experienced the greatest pain relief in symptomatic knee joints. Moreover, the remarkably linear inverse correlation between LN volume and joint pain observed in this small clinical pilot provides initial evidence to support the concept that dynamic changes in draining LN volume are a biomarker of clinical response to therapy in RA.
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.; Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Homaira
authors.initials: H
authors.lastname: Rahimi
authors.affiliation: Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Dieudonne
authors.affiliation: Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Valeriy
authors.initials: V
authors.lastname: Kheyfits
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.; Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.; Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Echoe M
authors.initials: EM
authors.lastname: Bouta
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.; Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Wood
authors.affiliation: Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Rick
authors.initials: R
authors.lastname: Barrett
authors.affiliation: Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Moorehead
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.; Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.; Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, USA.; Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Schwarz
authors.affiliation: Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.; Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Ritchlin
keywords: lymph node; rheumatoid arthritis; tumor necrosis factor inhibitor