RESEARCH - Monitoring anti-TNF treatment in RA: responsiveness of MRI and US of the dominant wrist joint

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Published Online First: 19 November 2008. doi:10.1136/ard.2008.091801

ls of the Rheumatic Diseases 2009;68:1572-1579

Extended report

Monitoring anti-TNF treatment in rheumatoid arthritis: responsiveness

of magnetic resonance imaging and ultrasonography of the dominant

wrist joint compared with conventional measures of disease activity

and structural damage

E A Haavardsholm1,2, M Østergaard3, H B Hammer1, P Bøyesen1,2, A

Boonen4, D van der Heijde1,5, T K Kvien1,2

1 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

2 Faculty of Medicine, University of Oslo, Norway

3 Department of Rheumatology, Copenhagen University Hospitals at

Hvidovre and Herlev, Copenhagen, Denmark

4 Department of Rheumatology, University Hospital Maastricht,

Maastricht, The Netherlands

5 Leiden University Medical Center, Leiden, The Netherlands

Objectives: To evaluate the responsiveness of magnetic resonance

imaging (MRI) and ultrasonography (US) compared with conventional

measures of disease activity and structural damage in patients with

rheumatoid arthritis (RA) during the first year of treatment with

anti-tumour necrosis factor (TNF).

Methods: A cohort of patients with RA (N = 36, median age 53 years,

disease duration 7.6 years and disease activity score (DAS28) 5.7) was

evaluated by core measures of disease activity, US (one wrist), MRI

(one wrist) and conventional radiography (CR, both hands and wrists)

at initiation of treatment with anti-TNF agents and after 3, 6 and 12

months. Responsiveness was assessed by standardised response means

(SRM). Accepted thresholds were applied to classify responsiveness as

trivial, low, moderate or good.

Results: MRI synovitis (SRM between –0.79 and –0.92) and the MRI total

inflammation score comprising synovitis, tenosynovitis and bone marrow

oedema (SRM between –1.05 and –1.24) were highly responsive. Moderate

to high responsiveness was found for MRI tenosynovitis and bone marrow

oedema, all the composite indices (DAS28, simplified disease activity

index (SDAI) and clinical disease activity index (CDAI)) and the

28-swollen joint count. US displayed low to moderate responsiveness.

The MRI erosion score displayed low responsiveness but was more

responsive than CR measures at 3 and 6 months follow-up. MRI and CR

measures of annual progression rates of damage performed similarly and

were highly responsive.

Conclusions: The most responsive measure of inflammation when

evaluating anti-TNF medication was a composite measure comprising MRI

synovitis, tenosynovitis and bone marrow oedema, and this may be a

promising outcome measure in clinical studies.

http://ard.bmj.com/cgi/content/abstract/68/10/1572?etoc

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