RESEARCH - Efficacy of Remicade on MRI determined bone edema in psoriatic arthritis

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Ann Rheum Dis. Published Online First: 21 December 2006.

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Extended Report

Efficacy of infliximab on MRI determined bone oedema in psoriatic arthritis

Helena Marzo-Ortega 1*, Dennis McGonagle 1, A 1, Ai Lyn Tan 1,

Philip G Conaghan 1, Philip O'Connor 2, F Tanner 1, Fraser

1, Veale 3 and Emery 1

1 University of Leeds, United Kingdom

2 Leeds General Infirmary, United Kingdom

3 St 's Hospital, Eire

Abstract

Background and aims: Psoriatic arthritis is commonly associated with bone

pathology including entheseal new bone formation and osteolysis. On MRI,

areas of active clinical involvement are represented by bone oedema and

synovitis. The purpose of this study was to assess the impact of infliximab

on bone oedema in PsA as shown by magnetic resonance imaging.

Methods: 18 patients with joint swelling, psoriasis and seronegativity for

rheumatoid factor received 4 infusions of infliximab 3 mg/kg in combination

with methotrexate. MRI of affected hand (12 patients) or knee joints (6

patients) was performed pre and post therapy. The primary outcome was the

assessment of bone oedema and synovitis at 20 weeks as shown by MRI.

Secondary outcomes included the ACR response criteria, psoriasis skin scores

(PASI) and a quality of life measure (PsAQoL).

Results: At baseline, bone oedema was seen in 50% of the patients (7 hands

and 2 knees) in 30% of scanned joints and this improved or resolved in all

cases in the hand joints (p=0.018) and one knee joint at 20 weeks. MRI

synovitis was reduced in 90% of cases. Likewise a statistically significant

improvement in all clinical outcomes was seen at week 20 including PASI

(p=0.003) and PsAQoL (p=0.006). 65% (n=11) of the patients achieved an ACR

response, of which 45% had ACR70 or above and 54% ACR20 or ACR50.

Conclusions: Infliximab therapy is associated with dramatic improvements in

MRI determined bone oedema in PsA in the short term. It remains to be

determined whether this translates into the prevention of radiographic new

bone formation, bone fusion or osteolysis in PsA.

http://ard.bmj.com/cgi/content/abstract/ard.2006.063818v1?papetoc

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