Can Bone Erosions Heal in Adalimumab (Humira) Treated Rheumatoid Arthritis Patients. An Imaging Study Using Computed Tomography and Magnetic Resonance Imaging.
Studies on tumor necrosis factor alpha antagonist (anti-TNF) therapy in rheumatoid arthritis
(RA) patients have found that radiographic erosions scores decreased in some patients. This
suggests that erosive damage may "heal" in some RA patients treated with anti-TNF. However,
it is not clarified whether the reduced scores are caused by technical issues as observer
variation and image acquisition differences. Furthermore, radiography of erosions is a 2D
representation of a 3D pathology and therefore not ideal for visualizing healing, if
present. Verification of erosion healing under anti-TNF therapy with adalimumab (Humira) by
optimal imaging methods, would markedly influence our perception of the effect and potential
of adalimumab (Humira) for modifying structural joint damage in RA. Magnetic Resonance
Imaging (MRI), allowing high-resolution 3D visualization of bone damage as well as the
inflammatory activity in the bone (bone marrow edema/osteitis), is more sensitive for
visualization of bone erosions than radiography. Computed Tomography (CT) is a 3D
radiographic imaging technique, which is not suited for assessment of inflammation, but can
be considered a reference method for assessment of bone damage, due to its direct 3D
visualization of calcified tissue. Internationally recommended MRI scoring systems as well
as methods for estimation of erosion volumes have been developed, with participation by our
research group. Ultrasonography (US), even though less validated, is more sensitive than
radiography and comparable to MRI in detecting bone erosions in RA joints. Additionally, US
provides visualisation of soft tissue changes and synovitis, using gray-scale and Doppler
US.
Repeated MRI, CT, US and radiographic examinations of RA joints with mild to moderate
radiographic damage under adalimumab (Humira) therapy will allow detailed assessment of the
extent of bone repair/healing during adalimumab (Humira) therapy.
Interventional
Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
By means of computed tomography and magnetic resonance imaging to investigate if repair of bone erosion occurs in rheumatoid arthritis joints during adalimumab (Humira) therapy
52 weeks
No
Mikkel Østergaard, Professor
Principal Investigator
Department of Rheumatology, Hvidovre University Hospital
Denmark: Ethics Committee
HUM 04-20
NCT00696059
August 2004
July 2007
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