Synovial inflammation analyzed by 3-T magnetic resonance imaging in etanercept-treated patients with rheumatoid arthritis indicates persistent disease activity despite of clinical remission: A pilot study

Objectives: To evaluate joint inflammation using 3-T MRI in rheumatoid arthritis (RA) patients treated with conventional disease modifying anti-rheumatic drugs (cDMARDs) as compared to inhibitors for tumor necrosis factor alpha (TNFi) over 12 months. Methods: Prospective epidemiologic clinical pilot study using the RA MRI system (RAMRIS), the visual analog scale (VAS, 0-100) and the Disease Activity Score 28-joint count (DAS28) at baseline, 4, and 12 months after initiation of etanercept (ETA). Ten patients with inadequate response to two cDMARDs were treated with ETA and compared to 10 patients responding to cDMARDs. Results: In cDMARD patients, parameters at baseline and 12 months did not change: VAS: 21.0 +/- 11.3 and 20.2 +/- 24.6; DAS28: 2.1 +/- 0.6 and 2.9 +/- 1.0; and RAMRIS: 11.0 +/- 2.3 and 11.8 +/- 2.8, respectively. In contrast, in the ETA-patients the same parameters were as follows at baseline, 4, and 12 months: VAS: 46.3 +/- 7.9, 23.9 +/- 7.1, and 24.0 +/- 6.3 (each p = .04); DAS28: 3.8 +/- 0.4, 2.8 +/- 0.3 (ns), and 2.5 +/- 0.3 (p = .01); and RAMRIS: 28.9 +/- 5.0, 25.8 +/- 4.7 (ns), and 24.6 +/- 4.5 (ns). Comparing ETA and cDMARD patients, RAMRIS was significantly different. Conclusion: The data suggest that synovial inflammation and DAS28 remission are separate entities in RA. MRI scoring before starting a treatment may therefore indicate the requirement for TNFi.