Background/Purpose: To test for initial status and subsequent recovery of cartilage glycosaminoglycane content in metacarpophalangeal joints (MCP) in patients with early rheumatoid arthritis (eRA) undergoing Methotrexate (MTX) therapy with delayed Gd(DTPA)2- enhanced MRI of the cartilage (dGEMRIC).
Methods: MCP II and III in 19 patients with eRA (disease duration less than 3 month) and 13 healthy volunteers were examined (eRA patients: 13 females, six males, mean age 51 years, range 25-69; eRA 6 months follow-up patients: 7 females, one male, mean age 48 years, range 33-68; healthy volunteers: ten females, three males, mean age 51 years, range 25-66). All eRA patients received methotrexate (MTX, monotherapy, 15mg subcutaneously). Laboratory parameters collected at baseline and follow-up were: ESR, CRP (mg/dl), DAS28. Remission was defined as DAS28<2,6. dGEMRIC was acquired using the variable flip angle techique (VFA). dGEMRIC index was measured in phalangeal and metacarpal cartilage of MCP II and III with manually drawn region-of-interest evaluation. Cartilage thickness was determined as a conventional measure of cartilage integrity. Statistical analysis used non-parametric Mann-Whitney-U-Test to test for significant differences between the groups.
Results: dGEMRIC index was significantly decreased in MCP-joints of eRA patients compared to healthy subjects at T0 (healthy volunteers: MCP II 488 ms ± 90 ms, MCP III 523 ms ± 100 ms; eRA patients: MCP II 414 ms ± 119 ms (p<0.05), MCP III 415 ms ± 132 ms (p<0.05)). Cartilage thickness was not significantly different between the groups. Following initial MTX therapy, remission (DAS28<2,6) was achieved in six out of eight patients. Mean increase of dGEMRIC index was 12 ms ± 180 ms (n.s.).
Conclusion: In therapy naive early RA, there was a decrease in cartilage glycosaminoglycane content in metacarpophalangeal joints in comparison to healthy controls in the MCP joints II und III. Glycosaminoglycane content as assessed with dGEMRIC of normal appearing finger cartilage did not significantly change after a six month MTX monotherapy despite clinical remission (based on DAS28) and could be a hint for silent progression. dGEMRIC may be a possible tool for studies on cartilage protection in RA therapy.
Disclosure:
D. P. Sewerin,
None;
D. F. Miese,
None;
D. H. J. Wittsack,
None;
D. S. Vordenbäumen,
None;
D. C. Schleich,
None;
P. D. G. Antoch,
None;
P. D. M. Schneider,
None;
P. D. B. Ostendorf,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-initial-methotrexate-therapy-on-cartilage-composition-in-early-rheumatoid-arthritis-follow-up-with-biochemical-mri-of-finger-cartilage/