Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

Abstract

We evaluated clinically and sonographically the effects of etanercept therapy in patients with rheumatoid arthritis (RA) over 12 months of treatment. Eighteen patients affected by RAwho were non-responders or partial responders to disease modifying therapy were commenced on Etanercept treatment. Before starting therapy (T0) and at 12 months (T1), the following parameters were evaluated: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) for pain, number of painful and swollen joints, health assessment questionnaire (HAQ) and disease activity score in 28 joints (DAS 28). Musculoskeletal ultrasound (US) was performed in the following joints: second and fifth metacarpophalangeal, third interphalangeal, wrist and knee joints and a semiquantitative score (0-3) calculated and used to indicate the presence of a localised inflammatory process (synovitis, tenosynovitis, bursitis) and/or structural damage (bone erosion and cartilaginous change). An overall score was calculated based on the sum of the single scores to obtain a comprehensive score indicative of the global pathological change. The US global scores significantly reduced between T0 and T1 (p<0.0001). The following laboratory and clinical parameters also significantly reduced: ESR (p<0.0001), CRP (p<0.02), VAS (p<0.001), number of total swollen joints (p<0.001), number of total painful joints (p<0.01), HAQ scores (p<0.05) and DAS 28 (p< 0.0001). A positive response to treatment with Etanercept was demonstrated both by US examination of several joints and by clinical evaluation of several parameters. US is a useful tool in the monitoring of biologic therapy in RA, assessing both inflammatory and destructive changes.

Power doppler ultrasonographic monitoring of response to anti–tumor necrosis factor therapy in patients with rheumatoid arthritis

“…Our results were in accordance with those of previous longitudinal studies that have shown changes in CDUS or PDUS findings associated with clinical and laboratory response to TNF blocking agents in RA patients (15,(17)(18)(19)(20)(21)(22)(23). Most of the earlier studies evaluated small numbers of patients (17)(18)(19)(20)22) and/or joints (17,(19)(20)(21) and/or had short followup periods (17,18), which probably limited the ability to investigate the responsiveness and predictive value of US findings in RA patients treated with anti-TNF agents.…”

“…We chose a combination of grayscale and PD findings as imaging variables reflecting rheumatoid joint inflammation. In addition, as in the studies by Iagnocco et al (22,23), we included findings on periarticular inflammation in the PDUS assessment.…”

“…Most of the earlier studies evaluated small numbers of patients (17)(18)(19)(20)22) and/or joints (17,(19)(20)(21) and/or had short followup periods (17,18), which probably limited the ability to investigate the responsiveness and predictive value of US findings in RA patients treated with anti-TNF agents.…”

“…Reports of several longitudinal studies (15,(17)(18)(19)(20)(21)(22)(23)) have described significant reduction of joint inflammation in RA as evaluated by gray-scale US, CDUS, or PDUS, after various durations of treatment with antitumor necrosis factor (anti-TNF), a therapy that has been widely demonstrated to be effective in RA (24)(25)(26). These studies have been conducted at individual research centers and have included a small number of patients and/or target joints (15,(17)(18)(19)(20)(21)(22)(23).…”

“…These studies have been conducted at individual research centers and have included a small number of patients and/or target joints (15,(17)(18)(19)(20)(21)(22)(23). Most of the previous studies have not evaluated the sensitivity to change of US parameters.…”