953 - Reduction In MRI Inflammation During Adalimumab Therapy In Patients with Psoriatic Arthritis – Implementation of the OMERACT PsAMRIS Scoring Method In a Follow-up Study

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
René Panduro Poggenborg1, Pernille Bøyesen2, Charlotte Wiell3, Susanne Juhl Pedersen3, Inge Juul Sørensen1, Ole Rintek Madsen3, Ole Slot1, Jakob M. Møller4, Maria Hasselquist4 and Mikkel Østergaard1, 1Copenhagen University Hospital in Glostrup, Copenhagen, Denmark, 2Diakonhjemmet Hospital, Oslo, Norway, 3Copenhagen University Hospital in Gentofte, Copenhagen, Denmark, 4Copenhagen University Hospital in Herlev, Copenhagen, Denmark
Presentation Number: 953

Background/Purpose:

To evaluate the changes in magnetic resonance imaging (MRI) parameters of disease activity and structural damage in patients with psoriatic arthritis (PsA) during 48 weeks of adalimumab therapy.

Method:

Patients were included if they had 1) PsA according to Moll and Wright's criteria; 2) ≥3 tender and ≥3 swollen joints; 3) ≥1 swollen finger joint and/or ≥1 dactylitis and 4) clinical indication for TNFα inhibitor. MRI (0.6 T) was performed at weeks 0 (at initiation of adalimumab 40 mg sc eow), 6, 24 and 48, of the 2nd-5th fingers (metacarpophalangeal, and proximal and distal interphalangeal joints) of the hand with the highest clinical disease activity at inclusion. MRIs were scored according to PsAMRIS (1) by a trained reader. MRI total inflammation score was calculated by adding the components of the synovitis, flexor tenosynovitis, periarticular inflammation and bone marrow oedema. Clinically, patients were evaluated according to PsARC-response at week 24. Responders continued treatment with adalimumab, whereas non-responders changed therapy at the discretion of the treating rheumatologist.

Result:

Patient (n=41) characteristics were: 18 (44%) males, median (interquartile range) age 49 (39-60) years, disease duration 9 (5-15) years, skin disease duration 23 (12-35) years, CRP 7 (4-14) mg/L, SJC 8 (5-16), TJC 21 (11-39), VAS pain 62 (49-73) mm, VAS global 65 (49-77) mm, VAS physician 50 (39-64) mm, HAQ-score 0.9 (0.4-1.4), MASES 13-enthesitis score 1 (0-2), dactylitis count 0 (0-2) and body surface area affected by psoriasis (BSA) 2 (1-5) %. SJC and TJC decreased significantly from baseline to week 6, 24 and 48 for clinical responders, whereas no decreases were seen in non-responders.

The table shows the PsAMRIS scores during 48 weeks of treatment with adalimumab.

Time (week)

0

6

24

48

All patients/PsARC-responders (n)

41/-

37/29

34/30

33/29

Synovitis (0-36)

9(6-14)

9(5-12)*; [10(5-12)]

8(4-12); [8(4-12)]

6(3-9)*; [7(4-9)]*

Flexor tenosynovitis (0-36)

2(0-6)

1(0-5)**; [2(0-5]**

1(0-4)*; [1(0-4)]*

1(0-3)**; [1(0-3]**

Periarticular inflammation (0-24)

0(0-1)

0(0-1); [0(0-2)]

0(0-1); [0(0-2)]

0(0-1); [0(0-1)]

Bone oedema (0-72)

0(0-2)

0 (0-2); [0(0-2)]

0(0-1); [0(0-0)]*

0(0-1); [0(0-1)]

Bone erosion (0-240)

2(1-6)

2(1-4); [3(1-4)]

2(0-6); [3(0-6)]

3(0-5); [3(0-5)]

Bone proliferation (0-12)

0(0-1)

0(0-1); [0(0-2)]

0(0-2); [0(0-2)]

0(0-1); [0(0-1)]

Total MRI inflammation (0-168)

16(8-22)

14(9-19)*; [15(9-19)]*

13(7-19)*; [13(8-18]

9(6-14)**; [9(7-14)]**

Values are medians (IQR). *p<0.05, **p<0.005, Wilcoxon signed-rank test. Values are for all examined patients at weeks 0, 6, 24 and 48 weeks, with values for PsARC responders given in squared brackets.

The baseline MRI very frequently showed synovitis (40 patient (98%)), whereas bone oedema was less common (18 patients (44%)). After 6 weeks, there was a significant decrease in synovitis, flexor tenosynovitis and total MRI inflammation scores. Flexor tenosynovitis and total MRI inflammation significantly had improved in the PsARC-responders (table). After 48 weeks both the pooled patient group and the responder group (but not non-responders) showed significantly decreased synovitis, flexor tenosynovitis and total MRI inflammation scores. Scores of periarticular inflammation, bone proliferation and bone erosion did not change significantly.

Conclusion:

Treatment with adalimumab in patients with active PsA reduces MRI signs of inflammation as assessed by the PsAMRIS method.

Reference. 1. Østergaard et al, J Rheumatol 2009 Aug;36(8):1816-24


Keywords: adalimumab, magnetic resonance imaging (MRI) and psoriatic arthritis

Disclosure: R. P. Poggenborg, None; P. Bøyesen, None; C. Wiell, None; S. J. Pedersen, None; I. J. Sørensen, None; O. R. Madsen, None; O. Slot, None; J. M. Møller, None; M. Hasselquist, None; M. Østergaard, None.