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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

MIKAEL BOESEN, LARS BOESEN, KARL ERIK JENSEN, MARCO AMEDEO CIMMINO, SØREN TORP-PEDERSEN, LENE TERSLEV, MERETE KOENIG, BENTE DANNESKIOLD-SAMSØE, HENRIK RØGIND, and HENNING BLIDDAL

ABSTRACT.

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. (J Rheumatol First Release Mar 1 2008)

Key Indexing Terms:

RHEUMATOID
METHYLPREDNISOLONE
MAGNETIC RESONANCE IMAGING
ULTRASOUND
DOPPLER


From The Parker Institute Frederiksberg Hospital; Rigshospitalet, Department of Radiology, MRI Section, Copenhagen, Denmark; and Rheumatologic Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy.

Supported by the OAK Foundation and the Meyers Foundation, and by Wyeth Inc.

M. Boesen, MD, PhD, Research Fellow; L. Boesen, MD; S. Torp-Pedersen, MD; L. Terslev, MD, PhD; M. Koenig, MD, PhD, Research Fellow; B. Danneskiold-Samsøe, MD, DMSC; H. Røgind, MD, PhD; H. Bliddal, MD, DMSC, Professor, The Parker Institute Frederiksberg Hospital; K.E. Jensen, MD, DMSC, Rigshospitalet, Department of Radiology, MRI Section; M.A. Cimmino, MD, Professor, Rheumatologic Clinic, Department of Internal Medicine, University of Genoa.

Address reprint requests to Prof. H. Bliddal, Parker Institute, Nordre Fasanvej 57, Frederiksberg Hospital, 2000 Frederiksberg, Copenhagen, Denmark. E-mail: parker@frh.regionh.dk

Accepted for publication November 29, 2007.



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