Vol.19 No.1

Original Article

Response of early active rheumatoid arthritis to tumor necrosis factor inhibitors: evaluation by magnetic resonance imaging

Authors

Wataru Hirose1 , Kenichiro Nishikawa1 , Masuko Hirose1 , Toshihiro Nanki2 , Hideharu Sugimoto3

  • The Hirose Clinic of Rheumatology, 2-14-7 Midori-chou, Tokorozawa Saitama, 359-1111, Japan
  • Department of Pharmacovigilance, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku Tokyo, 113-8519, Japan
  • Department of Radiology, Jichi Medical University Hospital, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke Tochigi, 329-0498, Japan
Received:

3 March 2008

Accepted:

7 July 2008

Published online:

2 September 2008

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Abstract

Inflammatory changes (synovitis and bone marrow edema) and destructive changes (bone erosion) were evaluated by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA), and their relations with disease activity were assessed during treatment with tumor necrosis factor (TNF) inhibitors. Ten patients with early active RA underwent MRI at 0 and 16 weeks of TNF-inhibitor treatment. The carpal bones of the dominant hand were evaluated by the outcome measures in rheumatology clinical trials MRI score for RA. After 16 weeks, the mean disease activity score (DAS 28) decreased significantly from 5.54 to 2.70, while the number of tender joints, number of swollen joints, and inflammatory parameters were also significantly improved. The mean synovitis and marrow edema scores determined by MRI showed a significant decrease from 6.1 to 2.2 and 12.8 to 6.2, respectively, while the annual bone-erosion progression score decreased from 12.6 to 2.0. Although synovitis persisted in some patients, imaging remission was achieved in two patients. In conclusion, TNF-inhibitor therapy achieved an early decrease of disease activity and MRI revealed amelioration of joint destruction. The MRI score for RA is useful for assessing the early response to TNF inhibitors.

Key words

Early rheumatoid arthritis - Magnetic resonance imaging - Tumor necrosis factor inhibitor