High resolution ultrasound detects a decrease in pannus vascularisation of small finger joints in patients with rheumatoid arthritis receiving treatment with soluble tumour necrosis factor α receptor (etanercept)

Abstract

Methods: Five patients with active RA were treated with etanercept, a soluble TNFα receptor protein, for one month. Before, during, and after treatment the patients were followed up by clinical rheumatological examination, determination of their subjective pain score, blood chemistry, and by HRUS of the second metacarpophalangeal (MCP) joint of the right hand.

Results: One month after treatment with etanercept, rheumatological examination showed a significant decrease in a modified single joint rheumatic disease activity index (from 2.9 (SD 0.2) to 1.2 (0.7); p<0.05) in all patients. Moreover, a significant decrease in the general pain score (from 4.7 (0.4) to 1.8 (0.6); p<0.05) and in C reactive protein (CRP) levels was seen (from 3.02 (0.9) to 0.24 (0.1); p<0.05). Concordantly, HRUS showed a significant reduction in pannus vascularisation of the MCPII joints (from 23 602 (5339) to 2907 (1609) colour signals/region of interest, CS/ROI; p<0.001). Pearson's correlation coefficient between the results obtained by HRUS and the clinical response was 0.85.

Conclusion: HRUS is promising as an additional useful method in the assessment of RA activity, and probably also in monitoring therapeutic responses.

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Figure 2 .

Box and whiskers graphs of clinical parameters obtained from five patients treated with etanercept for 28 days. (A) CRP; (B) total subjective pain score (SPS_total); (C) total rheumatic disease activity index (RDAI_total); (D) colour signals per region of interest (CS/ROI_II); (E) single joint disease activity index (RDAI_II) of the second MCP joints. Error bars correspond to the range of the respective values, boxes correspond to the 25% and 75% centiles and the bold horizontal bars to the median values. Individual variables were tested for significance by the Kruskal-Wallis test followed by Dunn's multiple comparison procedure. NS, not significant; ⁽*⁾p<0.1; *p<0.05; **p<0.001

Figure 1 .

Longitudinal (A) and transverse (B) scan of an MCPII joint of the right hand before treatment with etanercept, showing hypoechogenic pannus and a high degree of intra-articular vascularisation. Longitudinal (C) and transverse (D) scan of the same joint as shown in (A) and (B) during treatment with etanercept for 29 days. A significant decrease of intra-articular vascularisation can be seen.

Figure 3 .

Decrease in intra-articular vascularisation and clinical symptoms of five patients with active RA receiving treatment with etanercept. Values given correspond to the respective mean values obtained before (t=0) and during the study (days 8, 16, and 28). Error bars indicate the standard deviation of the respective mean values. The insert shows the Spearman correlation between the data obtained by HRUS (CS/ROI) and the clinical examination of the second MCPII joints (RDAI_II).