RESEARCH - Clinical outcome and imaging changes after intraarticular application of Enbrel or methylprednisolone in RA

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J Rheumatol. 2008 Mar 1 [Epub ahead of print]

Clinical Outcome and Imaging Changes After Intraarticular (IA)

Application of Etanercept or Methylprednisolone in Rheumatoid

Arthritis: Magnetic Resonance Imaging and Ultrasound-Doppler Show No

Effect of IA Injections in the Wrist After 4 Weeks.

Boesen M, Boesen L, Jensen KE, Cimmino MA, Torp-Pedersen S, Terslev L,

Koenig M, Danneskiold-Samsøe B, Røgind H, Bliddal H.

From The Institute Frederiksberg Hospital; Rigshospitalet,

Department of Radiology, MRI Section, Copenhagen, Denmark; and

Rheumatologic Clinic, Department of Internal Medicine, University of

Genoa, Genoa, Italy.

OBJECTIVE: To assess the magnetic resonance imaging (MRI) and

ultrasound (US) changes in the wrist of patients with rheumatoid

arthritis (RA) 4 weeks after an US guided intraarticular (IA)

injection. METHODS: Contrast enhanced MRI and US-Doppler were

performed at baseline and 4 weeks after IA injection of either 40 mg

methylprednisolone (n = 12) or 25 mg etanercept (n = 13) in 25

patients with RA taking disease modifying antirheumatic drugs with a

therapy-resistant wrist joint. All injections were US guided. RESULTS:

There was an improvement in swollen target joint score (p < 0.001),

tender target joint score (p < 0.002), and physician visual analog

scale score (p < 0.001) after 4 weeks. Baseline MRI synovitis score

was mean 5.08 (range 3-9) and was unchanged at followup in the whole

group (p = 0.52) and between treatment groups (p = 0.43). MRI edema

score (mean 4.46, range 0-29) in the total group was unchanged after 4

weeks (p = 0.13), whereas MRI erosion score increased in the total

group from baseline, 17.88 (range 7-40), to 4 weeks, 18.25 (range

7-40) (p < 0.001). Neither US-Doppler color fraction (0.07) nor

Resistive Index (RI) (p = 0.36) changed from baseline to 4 week

followup.

CONCLUSION: In contrast to the clinical evaluation, imaging measures

of relevance for the estimation of inflammation, US-Doppler, US RI,

MRI synovitis, and bone-marrow edema did not change 4 weeks after a

single IA injection of either methylprednisolone or etanercept in the

wrist. Within the same period, erosive progression in some patients

suggested that joints with active disease may deteriorate within as

little as 1 month, and that this development is not arrested by 1

injection. Given the small sample size of our study further studies

are required to confirm our results.

PMID: 18322991

http://www.ncbi.nlm.nih.gov/pubmed/18322991

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