Background
Methods
Subjects
Imaging studies
HR-pQCT
HR-pQCT image analysis
Radiographs and MRI and scoring
Statistical analysis
Results
Clinical results
All patients (n = 27) | MTX-only group (n = 10) | MTX + anti-TNFa group (n = 17) | |
---|---|---|---|
Age (years), mean ± SD | 51.9 ± 15.4 | 58.6 ± 15.8 | 47.7 ± 13.8 |
Sex (female:male) | 22:5 | 7:3 | 15:2 |
Ethnicity | |||
Hispanic or Latino | 25 | 10 | 15 |
Native Hawaiian or other Pacific Islanders | 1 | 0 | 1 |
African American | 1 | 0 | I |
Disease duration (years), mean ± SD | 6.5 ± 5.4 | 7.1 ± 5.2 | 5.7 ± 5.6 |
Body mass index (kg/m2), mean ± SD | 28.3 ± 7.1 | 24.5 ± 5.5 | 30.1 ± 7.6 |
Seropositivity of rheumatoid factor | 14 | 3 | 11 |
Anti-CCP antibody | 19 | 7 | 12 |
Cumulative prednisone dose (mg) | 4.5 ± 3.8 | 1.4 ± 2.2 | 4.9 ± 3.6 |
Total (n = 22) | MTX only group (n = 9) | MTX + anti-TNFα group (n = 13) | ||||||
---|---|---|---|---|---|---|---|---|
Mean ± SD | Baseline | 3 Months | Changes |
p value* | Baseline | 3 Months | Changes |
p value* |
Disease activity | ||||||||
Swollen joints | 0.7 ± 1.0 | 1.6 ± 1.8 | 0.9 ± 1.8 | 0.184 | 14.5 ± 3.9 | 6.3 ± 4.8 | -8.2 ± 6.6 |
<0.001
|
Tender joints | 0.7 ± 1.1 | 1.0 ± 1.3 | 0.3 ± 1.2 | 0.438 | 9.3 ± 6.2 | 4.4 ± 9.5 | -4.9 ± 9.9 | 0.086 |
Global assessment of patient | 7.4 ± 15.3 | 16.3 ± 25.7 | 8.9 ± 19.6 | 0.210 | 62.2 ± 16.8 | 41.4 ± 31.2 | -20.8 ± 26.6 |
0.015
|
Physician | 11.7 ± 10.9 | 14.1 ± 12.6 | 2.4 ± 9.4 | 0.459 | 42.8 ± 10.7 | 26.4 ± 12.1 | -16.4 ± 18.2 |
0.005
|
ESR unm h) (mm/h) | 18.0 ± 22.3 | 21.0 ± I8.3 | 3.0 ± 10.9 | 0.435 | 32.2 ± 21.9 | 29.7 ± 21.6 | -2.4 ± 12.9 | 0.490 |
CRP tmg/L) (mg/L) | 2.1 ± 1.1 | 4.6 ± 3.5 | 2.4 ± 2.9 |
0.034
| 21.9 ± 28.1 | 10.4 ± 9.8 | -11.5 ± 22.2 | 0.088 |
DAS-28-ESR | 1.9 ± 0.9 | 2.6 ± 0.9 | 0.7 ± 1.2 | 0.106 | 5.7 ± 1.1 | 3.8 ± 1.2 | -2.0 ± 0.9 |
<0.001
|
DAS-28-CRP | l.8 ± 0.7 | 2.4 ± 0.8 | 0.6 ± 0.6 |
0.032
| 5.4 ± 0.9 | 3.5 ± 1.0 | -I.7 ± 1.1 |
<0.001
|
HAQ | 0.5 ± 0.7 | 0.7 ± 0.8 | 0.2 ± 0.3 | 0.084 | 1.6 ± 0.7 | 1.0 ± 0.7 | -0.6 ± 0.6 |
0.001
|
Modified SHARP score | ||||||||
Total | 4.7 ± 6.0 | NA | NA | 26.1 ± 42.0 | NA | NA | ||
Erosion | 1.6 ± 2.6 | 13.5 ± 26.8 | ||||||
JSN | 3.1 ± 4.9 | 12.5 ± 17.0 | ||||||
RAMRIS score | ||||||||
JSN | 0.2 ± 0.4 | 0.3 ± 0.7 | 0.1 ± 0.3 | 0.347 | 5.9 ± 8.4 | 5.9 ± 8.5 | 0.0 ± 0.4 | <1.000 |
Synovitis | 3.2 ± 2.1 | 3.1 ± 2.1 | -0.1 ± 0.9 | 0.598 | 4.9 ± 2.6 | 3.9 ± 2.3 | -l.0 ± 2.1 | 0.126 |
Bone erosion | 2.6 ± 2.2 | 2.6 ± 2.6 | 0.0 ± 0.9 | <1.000 | 20.5 ± 33.4 | 21.2 ± 33.3 | 0.6 ± 1.2 | 0.171 |
Bone edema | 4.9 ± 4.0 | 4.9 ± 3.6 | 0.0 ± 1.1 | <1.000 | 9.7 ± 7.8 | 7.1 ± 6.3 | -2.6 ± 3.8 | 0.105 |
Bone erosion analysis
Total (n = 19) | MTX-only group (n = 9) | MTX + anti-TNFα group (n = 13) | ||||||
---|---|---|---|---|---|---|---|---|
Mean ± SD | Baseline | 3 Months | Changes (A) |
p value* | Baseline | 3 Months | Changes (A) |
p value* |
MCP2 | ||||||||
Erosion number (n) | 7 | 7 | 23 | 23 | ||||
Erosion volume (mm3) | 6.7 ± 6.4 | 7.5 ± 6.4 | 0.9 ± 0.5 |
0.006
| 41.4 ± 65.5 | 37.6 ± 60.3 | -3.8 ± 5.2 |
0.048
|
Joint space | ||||||||
Width (mm) | 1.81 ± 0.14 | 1.80 ± 0.13 | -0.01 ± 0.07 | 0.705 | 1.87 ± 0.20 | 1.80 ± 0.15 | -0.07 ± 0.09 |
0.028
|
Volume (mm3) | 133.6 ± 17.3 | 134.6 ± 16.0 | 1.0 ± 5.5 | 0.606 | 125.4 ± 20.5 | 118.7 ± 17.0 | -6.68 ± 7.08 | 0.001 |
MCH2 microarchitecture BMD (mg/cm3) | ||||||||
Total | 279.9 ± 34.2 | 277.4 ± 40.2 | -6.2 ± 16.1 | 0.288 | 316.2 ± 34.7 | 327.8 ± 45.9 | 11.6 ± 33.0 | 0.268 |
Trabecular | 236.2 ± 26.9 | 233.6 ± 33.2 | -2.6 ± 20.4 | 0.731 | 259.0 ± 25.6 | 266.9 ± 41.0 | 7.8 ± 26.8 | 0.353 |
MCP3 | ||||||||
Erosion number (n) | 4 | 4 | 13 | 13 | ||||
Erosion volume (mm3) | 2.3 ± 11.5 | 3.1 ± 1.2 | 0.8 ± 0.5 |
0.019
| 21.6 ± 31.5 | 18.9 ± 29.0 | -2.7 ± 2.5 |
0.014
|
Joint space | ||||||||
Width (mm) | 1.72 ± 0.14 | 1.74 ± 0.15 | 0.02 ± 0.05 | 0.226 | 1.83 ± 0.12 | 1.74 ± 0.14 | -0.10 ± 0.07 | 0.001 |
Volume (mm3) | 138.9 ± 17.0 | 142.1 ± 20.2 | 3.2 ± 4.3 | 0.069 | 131.9 ± 24.1 | 125.6 ± 21.4 | -4.3 ± 4.6 |
0.003
|
MCH3 microarchitecture BMD (mg/cm3) | ||||||||
Total | 279.9 ± 28.0 | 280.8 ± 25.0 | 1.0 ± 7.0 | 0.706 | 324.5 ± 35.7 | 321.8 ± 34.8 | -2.7 ± 8.4 | 0.298 |
Trabecular | 238.9 ± 20.1 | 241.9 ± 18.1 | 3.0 ± 8.1 | 0.322 | 269.4 ± 26.7 | 267.6 ± 26.1 | -1.7 ± 8.5 | 0.513 |
Distal radius | ||||||||
Erosion number (n) | 15 | 15 | 11 | 11 | ||||
Erosion volume (mm3) | 21.1 ± 26.4 | 23.4 ± 29.1 | 1.6 ± 3.3 | 0.075 | 199.9 ± 362.6 | 188.4 ± 331.4 | -15.5 ± 31.7 | 0.211 |
Joint space | ||||||||
Width (mm3) | 2.04 ± 0.24 | 2.04 ± 0.18 | -0.01 ± 0.12 | 0.981 | 2.09 ± 0.29 | 2.11 ± 0.29 | 0.01 ± 0.17 | 0.758 |
Volume (mm3) | 249.8 ± 29.3 | 261.1 ± 30.5 | 11.3 ± 22.3 | 0.197 | 247.5 ± 67.1 | 240.2 ± 71.2 | -7.3 ± 25.0 | 0.356 |
Wrist microarchitecture BMD (mg/cm3) | ||||||||
Total | 272.3 ± 61.3 | 272.8 ± 60.3 | 0.6 ± 4.3 | 0.709 | 356.0 ± 58.6 | 354.0 ± 58.4 | -2.0 ± 7.1 | 0.357 |
Cortical | 793.7 ± 82.9 | 792.1 ± 83.2 | -1.6 ± 9.8 | 0.663 | 873.4 ± 42.7 | 874.9 ± 43.7 | 1.5 ± 9.7 | 0.607 |
Trabecular | 148.0 ± 31.0 | 148.6 ± 30.8 | 0.6 ± 2.7 | 0.543 | 174.5 ± 53.7 | 172.0 ± 51.2 | -2.5 ± 5.1 | 0.115 |
Cortical thickness (μm) | 607.8 ± 200.4 | 606.7 ± 199.5 | 3.8 ± 21.2 | 0.900 | 824.6 ± 142.7 | 830.8 ± 140.8 | 6.2 ± 27.3 | 0.450 |
Trabecular | ||||||||
Number | 1.82 ± 0.14 | 1.80 ± 0.17 | -0.02 ± 0.15 | 0.748 | 1.97 ± 0.45 | 1.94 ± 0.42 | -0.03 ± 0.10 | 0.315 |
Thickness (μm) | 68.9 ± 12.6 | 69.9 ± 12.6 | 1.4 ± 5.0 | 0.441 | 72.9 ± 10.8 | 73.1 ± 10.2 | 0.2 ± 4.1 | 0.898 |
Separation (μm) | 485.7 ± 51.1 | 491.2 ± 60.0 | 5.6 ± 45.6 | 0.740 | 471.5 ± 171.7 | 475.1 ± 156.3 | 3.6 ± 34.8 | 0.725 |