Format

Send to

Choose Destination
Arthritis Res Ther. 2017 Oct 4;19(1):222. doi: 10.1186/s13075-017-1430-x.

Assessment of 3-month changes in bone microstructure under anti-TNFα therapy in patients with rheumatoid arthritis using high-resolution peripheral quantitative computed tomography (HR-pQCT).

Author information

1
Department of Radiology & Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA. simitom@wg8.so-net.ne.jp.
2
Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan. simitom@wg8.so-net.ne.jp.
3
Department of Radiology & Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA.
4
Department of Internal Medicine, Division of Rheumatology, Gachon University Gil Hospital, Incheon, Korea.
5
Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

Abstract

BACKGROUND:

Although one study showed minimal progression of erosions in patients with rheumatoid arthritis (RA) one year after TNFα inhibition therapy, no studies have investigated very early bone changes after initiation of anti-TNFα treatment. We investigated the effects of 3-month anti-TNFα treatment on bone erosion progression and bone microarchitecture in RA patients using high-resolution peripheral quantitative computed tomography (HR-pQCT).

METHODS:

Patients with RA (n = 27) (17 in the anti-TNFα and 10 in the MTX-only group) underwent assessment of disease activity score in 28 joints (DAS-28), radiographs, 3-T magnetic resonance imaging (MRI) and HR-pQCT of metacarpophalangeal and wrist joints at baseline and 3 months. HR-pQCT-derived erosion volume, joint volume/width and bone microarchitecture were computed and joint destruction was assessed using Sharp and RAMRIS scorings on radiographs and MRI, respectively.

RESULTS:

Overall, 73 erosions were identified by HR-pQCT at baseline. Over 3 months, the anti-TNFα group had decreased mean erosion volume; increased erosion volume was observed in one clinical non-responder. The MTX-only group in contrast, trended toward increasing erosion volume despite low disease activity. In the anti-TNFα group, joint-space width and volume of MCP joints decreased significantly and was positively correlated with erosion volume changes (R 2 = 0.311, p = 0.013; R 2 = 0.527, p = 0.003, respectively). In addition, erosion volume changes were significantly negatively correlated with changes in trabecular bone mineral density (R 2 = 0.353, p = 0.020) in this group. We observed significant correlation between percentage change in erosion volume and change in DAS-28 erythrocyte sedimentation rate and C-reactive protein CRP scores (R 2 = 0.558, p < 0.001; R 2 = 0.745, p < 0.001, respectively) in all patients.

CONCLUSIONS:

Using HR-pQCT, our data suggest that anti-TNFα treatment prevents erosion progression and deterioration of bone microarchitecture within the first 3 months of treatment, one patient not responding to treatment, had significant progression of bone erosions within this short time period. Patients with low disease activity scores (<3.2) can have continuous HR-pQCT-detectable progression of erosive disease with MTX treatment only. HR-pQCT can be a sensitive, powerful tool to quantify bone changes and monitor RA treatment short term (such as 3 months).

KEYWORDS:

Anti-tumor necrosis factor alpha; Bone erosion; High-resolution peripheral quantitative computed tomography; Rheumatoid arthritis

PMID:
28978352
PMCID:
PMC5628475
DOI:
10.1186/s13075-017-1430-x
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center