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Psoriatic arthritis patients on biologic therapy reported a decrease in pain, but MR imaging of their joints showed that there was still active disease, researchers reported here.
Among 29 patients who responded to treatment with adalimumab (Humira), the patient perception of pain dropped markedly as measured on a visual analog scale from 62 at baseline to 12 at week 48 (P<0.0001), said Rene Poggenborg, MD, research fellow in rheumatology at Glostrup University Hospital, Copenhagen.
"A surprising finding was that the synovitis -- the inflammation of the joint -- did not decrease very much," Poggenborg told MedPage Today at his poster presentation during the annual meeting of the American College of Rheumatology.
At baseline the PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Scale) score was a 9, and after a year it was a 6 (on a scale of 0 to 36).
"While this was of borderline significance (P<0.05), it did not correlate with clinical response, which was very good," he said. "So we had a very good clinical outcome, but not much of an improvement radiologically. We were able to document, using a contrast agent, that inflammation in the joints of patients disappeared after 48 weeks of treatment."
Poggenborg noted that the use of MRI to assess outcomes in these patients is useful, but is also time-consuming. "It takes a while to do the scoring on these scans; I estimate it takes about an hour per patient," he said.
"We had 29 responders among the 41 patients in the study. There were dropouts and in others, for some reason, adalimumab didn't appear to work. This is one way to monitor how well patients are doing on certain treatments," Poggenborg added.
"There is a disconnect between clinical remission and MRI remission in patients with rheumatoid arthritis," commented Amanda Brown, MD, assistant professor of pediatrics at Children's Hospital New Orleans at the Louisiana State University Health Science Center. "Some of the adult data has shown about a six-month difference."
In Poggenborg's study, more than half the patients were women and the average age of the study cohort was 49. They had experienced skin disease for about 20 years and had experienced joint disease for about nine years.
In the visual analog scale of global discomfort, the baseline score was 65. At 48 weeks, the responders had a score of 11 (P<0.0001). The visual analog scale using the doctors' perception of pain was 50 at baseline and 3 among responders after 48 weeks of therapy (P<0.0001), Poggenborg reported.
In addition to the decrease in synovitis, flexor tenosynovitis decreased from 2 to 1 on a scale of 0 to 36 (P<0.005). Bone erosion scores increased from 2 at baseline to 3 after a week of treatment on a scale of 0 to 240 (P=NS); and the overall MRI inflammation score decreased from 16 to 9 on a scale of 0 to 168 (P<0.005).
Poggenborg said the patient population had relatively early disease so there wasn't much bone damage, but even after a year of therapy, the MRI still indicated some disease activity persisted.
"Once the joints are clinically silent there is still activity on MRI," Brown told MedPage Today. "We have the opportunity to put these patients in remission with biologics, but are we really putting them into remission?"
Brown, who presented a similar study of imaging among pediatric patients with forms of rheumatoid arthritis, but who was not a researcher on the Danish study, noted, "One of the goals in rheumatoid arthritis is to treat to target, but is this really enough? Is this mild synovitis we see on MRI clinically important or are we just finding it because we are looking for it?
"I think there definitely is a lag time between clinical improvement and imaging improvement, but we don't know how long that is," she said. Brown added that although treatment with biologics can put patients in clinical, and eventual radiological remission from rheumatoid diseases, few patients ever return to baseline.
Source: medpagetoday.com
Among 29 patients who responded to treatment with adalimumab (Humira), the patient perception of pain dropped markedly as measured on a visual analog scale from 62 at baseline to 12 at week 48 (P<0.0001), said Rene Poggenborg, MD, research fellow in rheumatology at Glostrup University Hospital, Copenhagen.
"A surprising finding was that the synovitis -- the inflammation of the joint -- did not decrease very much," Poggenborg told MedPage Today at his poster presentation during the annual meeting of the American College of Rheumatology.
At baseline the PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Scale) score was a 9, and after a year it was a 6 (on a scale of 0 to 36).
"While this was of borderline significance (P<0.05), it did not correlate with clinical response, which was very good," he said. "So we had a very good clinical outcome, but not much of an improvement radiologically. We were able to document, using a contrast agent, that inflammation in the joints of patients disappeared after 48 weeks of treatment."
Poggenborg noted that the use of MRI to assess outcomes in these patients is useful, but is also time-consuming. "It takes a while to do the scoring on these scans; I estimate it takes about an hour per patient," he said.
"We had 29 responders among the 41 patients in the study. There were dropouts and in others, for some reason, adalimumab didn't appear to work. This is one way to monitor how well patients are doing on certain treatments," Poggenborg added.
"There is a disconnect between clinical remission and MRI remission in patients with rheumatoid arthritis," commented Amanda Brown, MD, assistant professor of pediatrics at Children's Hospital New Orleans at the Louisiana State University Health Science Center. "Some of the adult data has shown about a six-month difference."
In Poggenborg's study, more than half the patients were women and the average age of the study cohort was 49. They had experienced skin disease for about 20 years and had experienced joint disease for about nine years.
In the visual analog scale of global discomfort, the baseline score was 65. At 48 weeks, the responders had a score of 11 (P<0.0001). The visual analog scale using the doctors' perception of pain was 50 at baseline and 3 among responders after 48 weeks of therapy (P<0.0001), Poggenborg reported.
In addition to the decrease in synovitis, flexor tenosynovitis decreased from 2 to 1 on a scale of 0 to 36 (P<0.005). Bone erosion scores increased from 2 at baseline to 3 after a week of treatment on a scale of 0 to 240 (P=NS); and the overall MRI inflammation score decreased from 16 to 9 on a scale of 0 to 168 (P<0.005).
Poggenborg said the patient population had relatively early disease so there wasn't much bone damage, but even after a year of therapy, the MRI still indicated some disease activity persisted.
"Once the joints are clinically silent there is still activity on MRI," Brown told MedPage Today. "We have the opportunity to put these patients in remission with biologics, but are we really putting them into remission?"
Brown, who presented a similar study of imaging among pediatric patients with forms of rheumatoid arthritis, but who was not a researcher on the Danish study, noted, "One of the goals in rheumatoid arthritis is to treat to target, but is this really enough? Is this mild synovitis we see on MRI clinically important or are we just finding it because we are looking for it?
"I think there definitely is a lag time between clinical improvement and imaging improvement, but we don't know how long that is," she said. Brown added that although treatment with biologics can put patients in clinical, and eventual radiological remission from rheumatoid diseases, few patients ever return to baseline.
Source: medpagetoday.com