RESEARCH - Erosive progression is minimal, but erosion healing rare, in patients with RA treated with Humira

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Published Online First: 19 November 2008. doi:10.1136/ard.2008.097048

ls of the Rheumatic Diseases 2009;68:1585-1590

Extended report

Erosive progression is minimal, but erosion healing rare, in patients

with rheumatoid arthritis treated with adalimumab. A 1 year

investigator-initiated follow-up study using high-resolution computed

tomography as the primary outcome measure

U Møller Døhn1, A Boonen2, M L Hetland1,3, M S Hansen4, L S Knudsen4,

A Hansen5, O R Madsen6, M Hasselquist7, J M Møller7, M Østergaard1,4

1 Department of Rheumatology, Copenhagen University Hospital at

Hvidovre, Hvidovre, Denmark

2 Department of Internal Medicine, Division of Rheumatology,

Maastricht University Hospital, Maastricht, The Netherlands

3 The DANBIO registry, Copenhagen University Hospital at Hvidovre,

Hvidovre, Denmark

4 Department of Rheumatology, Copenhagen University Hospital, Herlev, Denmark

5 Department of Rheumatology, Copenhagen University Hospital,

Rigshospitalet, Denmark

6 Department of Rheumatology, Copenhagen University Hospital at

Gentofte, Gentofte, Denmark

7 Department of Diagnostic Radiology, Copenhagen University Hospital

at Herlev, Herlev, Denmark

Objective: With computed tomography (CT) and radiography, to

investigate if repair of bone erosions, defined as regression of

erosion scores, occurs during adalimumab treatment of patients with

rheumatoid arthritis (RA).

Methods: Fifty-two patients with RA, naïve to biological agents, with

at least two low-grade radiographic erosions in the wrist or

metacarpophalangeal (MCP) joints in the same (index) hand, initiated

adalimumab 40 mg subcutaneously every other week. Thirty-five patients

completed the study (median age 61 years (interquartile range 46–68),

disease duration 8 years (3–15)). CT of the index wrist and MCP joints

2–5 and radiographs of hands and forefeet were obtained at baseline, 6

and 12 months. Images were evaluated by investigators blinded to

chronology and clinical data, and assessed according to Sharp/van der

Heijde (radiographs) and OMERACT RA MRI scoring (CT) methods.

Results: Disease activity score, C-reactive protein, tender and

swollen joints count and Health Assessment Questionnaire score had all

decreased at 6 and 12 months (wilcoxon signed-ranks test p<0.001). No

significant change in any imaging parameters of joint destruction was

observed at 6 and 12 months. High intrareader agreements were reached

(mean intraobserver intraclass coefficients: 0.96 (CT) and 0.97

(radiography)). The number of patients with change scores exceeding

the smallest detectable change (SDC) was comparable on CT and

radiography, as were the proportions of patients

progressing/regressing. Decreased erosion scores at 12 months were

registered in 1.6% and 1.8% of sites assessed on CT and radiography,

respectively.

Conclusion: Repair of erosions in adalimumab-treated patients with RA

is rare, but erosive regression, exceeding the SDC, on CT and

radiography occurred. The very limited overall erosive progression

supports the view that joint destruction is minimal during adalimumab

treatment of patients with RA.

http://ard.bmj.com/cgi/content/abstract/68/10/1585?etoc

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