ASSOCIATION BETWEEN RADIOGRAPHIC PROGRESSION AND PERSISTENT VASCULAR SIGNAL ON POWER DOPPLER IMAGING IN EARLY RHEUMATOID ARTHRITIS

P.C. Taylor, A. Steuer , J. Gruber , C. McClinton , C. Wagner , P. Marsters , R.N. Maini Kennedy Institute of Rheumatology Division and Imaging Sciences Department, Faculty of Medicine, Imperial College, London, United Kingdom, Clinical Pharmacology, Biostatistics, Centocor Research and Development, Inc., Malvern, United StatesObjectives: In a study comparing early with delayed infliximab therapy in methotrexate (MTX)-treated, erosive, early rheumatoid arthritis (RA), we investigated relationships between remission assessed by quantitative power Doppler (PD) vascular signal in metacarpophalangeal joints (MCPs) and progression of radiographic damage over 2 years.Methods: Twenty-two patients with erosive early RA (<3 years) on stable MTX (12.5 to 17.5 mg/wk) were randomized in a double-blinded study to receive infliximab (5 mg/kg) or placebo at weeks 0, 2, 6, and then every 8 weeks through week 46. After week 18, MTX was increased if any patient failed to achieve a 50% reduction from baseline in the number of swollen hand and wrist joints. MCPs were scanned by PD, using a 15L8 Sequoia transducer (Acuson, USA), at weeks 0 and 54. Following week 54, all patients received infliximab. Three patients withdrew from the study by week 110. For each MCP joint, the number of PD pixels in images demonstrating maximal vascular signal was determined and the total PD area (PDA) calculated as the sum of the individual joint scores (range in this study 0-163111). PDA remission was defined as a score less than 500. Radiographs of the hands and feet, taken at baseline and weeks 54 and 110, were evaluated for the total Sharp score as modified by van der Heijde (SHS) method. Differences in SHS progression for patients with or without PDA remission at week 54 and 110 were compared by the Mann-Whitney U test.Results: The change in SHS from baseline to weeks 54 and 110 by PDA remission status is tabulated below: PDA Remission N Mean STD Median Q1 Q3 P value No:Week 54 11 10.6 10.6 8.0 1.0 19.5 0.250 Yes:Week 54 11 4.5 5.4 3.0 1.5 4.0 0.250 No:Week 110 6 20.7 17.3 13.5 9.0 33.0 0.039 Yes:Week 110 13 9.2 13.1 4.0 3.5 8.0 0.039 Conclusion: These findings indicate that the presence of a persistent vascular signal in MCP joints on power Doppler imaging is associated with greater radiographic progression and implicate vascular tissue in the pathogenesis of joint destruction in early RA.Citation: Ann Rheum Dis, volume 65, supplement II, year 2006, page 505Session: Rheumatic arthritis – treatment biologics