Marie Feletar1, Stephen Hall1, Paul Bird2. 1. From the Department of Rheumatology, Emeritus Research, Victoria; Department of Rheumatology, Institution for Rehabilitation Research, University of Melbourne, Melbourne; Department of Medicine, University of New South Wales, Sydney, Australia.M. Feletar, MBBS, FRACP, Department of Rheumatology, Emeritus Research; S. Hall, MBBS, BSc, FRACP, Department of Rheumatology, Institution for Rehabilitation Research, University of Melbourne, Emeritus Research; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip Magnetic Resonance Imaging, Conjoint Associate Professor, Department of Medicine, University of New South Wales. 2. From the Department of Rheumatology, Emeritus Research, Victoria; Department of Rheumatology, Institution for Rehabilitation Research, University of Melbourne, Melbourne; Department of Medicine, University of New South Wales, Sydney, Australia.M. Feletar, MBBS, FRACP, Department of Rheumatology, Emeritus Research; S. Hall, MBBS, BSc, FRACP, Department of Rheumatology, Institution for Rehabilitation Research, University of Melbourne, Emeritus Research; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip Magnetic Resonance Imaging, Conjoint Associate Professor, Department of Medicine, University of New South Wales. pbird@optimusresearch.com.au.
Abstract
OBJECTIVE: To assess the responsiveness of high- and low-field extremity magnetic resonance imaging (MRI) variables at multiple timepoints in the first 12 weeks post-antitumor necrosis factor (anti-TNF) therapy initiation in patients with psoriatic arthritis (PsA) and active dactylitis. METHODS: Twelve patients with active PsA and clinical evidence of dactylitis involving at least 1 digit were recruited. Patients underwent sequential high-field conventional (1.5 Tesla) and extremity low-field MRI (0.2 Tesla) of the affected hand or foot, pre- and postgadolinium at baseline (pre-TNF), 2 weeks (post-TNF), 6 weeks, and 12 weeks. A blinded observer scored all images on 2 occasions using the PsA MRI scoring system. RESULTS: Eleven patients completed the study, but only 6 patients completed all high-field and low-field MRI assessments. MRI scores demonstrated rapid response to TNF inhibition with score reduction in tenosynovitis, synovitis, and osteitis at 2 weeks. Intraobserver reliability was good to excellent for all variables. High-field MRI demonstrated greater sensitivity to tenosynovitis, synovitis, and osteitis and greater responsiveness to change posttreatment. Treatment responses were maintained to 12 weeks. CONCLUSION: This study demonstrates the use of MRI in detecting early response to biologic therapy. MRI variables of tenosynovitis, synovitis, and osteitis demonstrated responsiveness posttherapy with high-field scores more responsive to change than low-field scores.
OBJECTIVE: To assess the responsiveness of high- and low-field extremity magnetic resonance imaging (MRI) variables at multiple timepoints in the first 12 weeks post-antitumor necrosis factor (anti-TNF) therapy initiation in patients with psoriatic arthritis (PsA) and active dactylitis. METHODS: Twelve patients with active PsA and clinical evidence of dactylitis involving at least 1 digit were recruited. Patients underwent sequential high-field conventional (1.5 Tesla) and extremity low-field MRI (0.2 Tesla) of the affected hand or foot, pre- and postgadolinium at baseline (pre-TNF), 2 weeks (post-TNF), 6 weeks, and 12 weeks. A blinded observer scored all images on 2 occasions using the PsA MRI scoring system. RESULTS: Eleven patients completed the study, but only 6 patients completed all high-field and low-field MRI assessments. MRI scores demonstrated rapid response to TNF inhibition with score reduction in tenosynovitis, synovitis, and osteitis at 2 weeks. Intraobserver reliability was good to excellent for all variables. High-field MRI demonstrated greater sensitivity to tenosynovitis, synovitis, and osteitis and greater responsiveness to change posttreatment. Treatment responses were maintained to 12 weeks. CONCLUSION: This study demonstrates the use of MRI in detecting early response to biologic therapy. MRI variables of tenosynovitis, synovitis, and osteitis demonstrated responsiveness posttherapy with high-field scores more responsive to change than low-field scores.
Entities:
Keywords:
DACTYLITIS; MAGNETIC RESONANCE IMAGING; PSORIATIC ARTHRITIS; PsAMRIS