Department of Radiology & Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA.
Department of Orthopedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Arthritis Res Ther. 2017 Oct 4;19(1):222. doi: 10.1186/s13075-017-1430-x.
Although one study showed minimal progression of erosions in patients with rheumatoid arthritis (RA) one year after TNFα inhibition therapy, no studies have investigated very early bone changes after initiation of anti-TNFα treatment. We investigated the effects of 3-month anti-TNFα treatment on bone erosion progression and bone microarchitecture in RA patients using high-resolution peripheral quantitative computed tomography (HR-pQCT).
Patients with RA (n = 27) (17 in the anti-TNFα and 10 in the MTX-only group) underwent assessment of disease activity score in 28 joints (DAS-28), radiographs, 3-T magnetic resonance imaging (MRI) and HR-pQCT of metacarpophalangeal and wrist joints at baseline and 3 months. HR-pQCT-derived erosion volume, joint volume/width and bone microarchitecture were computed and joint destruction was assessed using Sharp and RAMRIS scorings on radiographs and MRI, respectively.
Overall, 73 erosions were identified by HR-pQCT at baseline. Over 3 months, the anti-TNFα group had decreased mean erosion volume; increased erosion volume was observed in one clinical non-responder. The MTX-only group in contrast, trended toward increasing erosion volume despite low disease activity. In the anti-TNFα group, joint-space width and volume of MCP joints decreased significantly and was positively correlated with erosion volume changes (R = 0.311, p = 0.013; R = 0.527, p = 0.003, respectively). In addition, erosion volume changes were significantly negatively correlated with changes in trabecular bone mineral density (R = 0.353, p = 0.020) in this group. We observed significant correlation between percentage change in erosion volume and change in DAS-28 erythrocyte sedimentation rate and C-reactive protein CRP scores (R = 0.558, p < 0.001; R = 0.745, p < 0.001, respectively) in all patients.
Using HR-pQCT, our data suggest that anti-TNFα treatment prevents erosion progression and deterioration of bone microarchitecture within the first 3 months of treatment, one patient not responding to treatment, had significant progression of bone erosions within this short time period. Patients with low disease activity scores (<3.2) can have continuous HR-pQCT-detectable progression of erosive disease with MTX treatment only. HR-pQCT can be a sensitive, powerful tool to quantify bone changes and monitor RA treatment short term (such as 3 months).
尽管有一项研究表明，在接受 TNFα 抑制剂治疗一年后，类风湿关节炎（RA）患者的侵蚀进展最小，但尚无研究调查抗 TNFα 治疗开始后非常早期的骨变化。我们使用高分辨率外周定量计算机断层扫描（HR-pQCT）研究了 3 个月抗 TNFα 治疗对 RA 患者骨侵蚀进展和骨微观结构的影响。
27 例 RA 患者（17 例接受抗 TNFα 治疗，10 例仅接受 MTX 治疗）在基线和 3 个月时接受了 28 关节疾病活动评分（DAS-28）、影像学检查、3T 磁共振成像（MRI）和掌指关节和腕关节的 HR-pQCT 评估。通过 HR-pQCT 计算侵蚀体积、关节体积/宽度和骨微观结构，并分别使用影像学和 MRI 的 Sharp 和 RAMRIS 评分评估关节破坏。
总体而言，基线时 HR-pQCT 共发现 73 个侵蚀。在 3 个月内，抗 TNFα 组的平均侵蚀体积减少；一名临床无反应者的侵蚀体积增加。相比之下，MTX 仅治疗组尽管疾病活动度低，但侵蚀体积呈增加趋势。在抗 TNFα 组中，MCP 关节的关节间隙宽度和体积明显减少，与侵蚀体积变化呈正相关（R=0.311，p=0.013；R=0.527，p=0.003）。此外，该组中侵蚀体积的变化与小梁骨密度的变化呈显著负相关（R=0.353，p=0.020）。我们观察到所有患者中，侵蚀体积的百分比变化与 DAS-28 红细胞沉降率和 CRP 评分的变化之间存在显著相关性（R=0.558，p<0.001；R=0.745，p<0.001）。
使用 HR-pQCT，我们的数据表明，抗 TNFα 治疗可在治疗的前 3 个月内预防侵蚀进展和骨微观结构恶化，一名对治疗无反应的患者在这段短时间内骨侵蚀明显进展。疾病活动评分较低（<3.2）的患者仅接受 MTX 治疗即可出现 HR-pQCT 检测到的侵蚀性疾病的持续进展。HR-pQCT 是一种敏感、强大的工具，可用于量化骨骼变化并监测 RA 治疗的短期效果（例如 3 个月）。
