SHORT-TERM FOLLOW-UP OF RA PATIENTS TREATED WITH RITUXIMAB BY EXTREMITY-DEDICATED MRI: DYNAMIC MRI IS MORE SENSITIVE THAN RAMRIS IN THE EVALUATION OF SYNOVITIS
M. Parodi1, G. Zampogna1, F. Barbieri1, F. Paparo2, G. Garlaschi2, M. Cutolo1, M.A. Cimmino1 1Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine; 2Sezione di Diagnostica per Immagini, Università di Genova, Genova, Italy
Background: MRI is a sensitive method to follow-up patients affected by rheumatoid arthritis (RA). In particular, it is useful to monitor the effect of biologic agents, which show often rapid and sustained effect.
Objectives: to assess prospectively the effect of rituximab (RTX) on MRI features of wrist joint disease in patients affected by RA.
Methods: 10 patients (6F/4M, mean age 52.9±15.5 years) diagnosed with IgM rheumatoid factor, anti CCP positive, RA according to the ACR criteria were treated with a single course of RTX (2 infusions of 1000 mg, 15 days apart). MRI of the dominant hand was performed with a 0.2T extremity-dedicated machine using pre and post contrast T1 weighted SE, turbo 3D, and STIR sequences at baseline, and after 4 and 24 weeks. MRI was analyzed using the OMERACT-RAMRIS score and the dynamic contrast-enhanced technique for wrist synovitis, which calculates the enhancement ratio as both rate of early enhancement (REE) and relative enhancement (RE).
Results: DAS significantly decreased during the study period (ANOVA for repeated measures, p=0.0007). The RAMRIS score did not change along the study, whereas the dynamic MRI value RE significantly decreased. RE, but not the RAMRIS synovitis score, significantly correlated with DAS at baseline, 1 and 6 months (p=0.005, 0.04, and 0.0007, respectively).
Table 1. Changes of clinical, laboratory and MRI findings in RA patients treated with one course of rituximab |
|||||
|
|
Baseline |
1 month |
3 months |
6 months |
p |
|
DAS 28 |
5.8±0.9 |
5.4±1.5 |
4.2±1.5 |
4.4±1.4 |
0.0006 |
|
Tender joint count |
14.5±6.5 |
12±9.5 |
8.7±8.2 |
8.6±8.6 |
0.04 |
|
HAQ |
1.9±0.6 |
1.5±0.8 |
0.8±0.7 |
1±0.8 |
0.0006 |
|
CRP (mg/L) |
14.2 (5.7-87.3) |
14 (3.4-73.1) |
10.6 (3.4-37.5) |
12 (3.4-90) |
0.19 |
|
IgM rheumatoid factor (IU/ml) |
145 (48.5-2660) |
ND |
107.2 (39.8-1140) |
96.8 (20.8-994) |
<0.001 |
|
OMERACT RAMRIS synovitis score (0-9) |
3.4±1.6 |
2.8±2.7 |
ND |
2.4±1.7 |
0.12 |
|
OMERACT RAMRIS bone oedema score (0-69) |
23.2±13.6 |
23.8±15.7 |
ND |
24±14.7 |
0.88 |
|
OMERACT RAMRIS erosion score (0-230) |
7.9±3.6 |
8.1±3.6 |
ND |
9.1±4.4 |
0.14 |
|
REE |
0.4±0.3 |
0.6±0.7 |
ND |
0.3±0.3 |
0.67 |
|
RE |
64.6±40.7 |
52.6±51.7 |
ND |
32.7±24.6 |
0.009 |
Values in brackets are measure units or range of the MRI variable; ND=not done.
Conclusion: RTX showed good clinical efficacy, which was paralleled by a decrease in dynamic MRI results. On the contrary, the traditional RAMRIS measures did not change. The erosion score remained unchanged, which fact may indicate a protective role by RTX on the development of new erosions. In comparison with the RAMRIS score, dynamic MRI proved better to evaluate short-term changes of RA synovitis.
Disclosure of Interest: None declared
Citation: Ann Rheum Dis 2010;69(Suppl3):380
http://www.abstracts2view.com/eular/view.php?nu=EULAR10L_FRI0197&terms=