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ABSTRACTS Presentations at the annual spring meeting of The Danish Society for Rheumatology, Rungstedgaard, April 29–30, 2005 DO PATIENTS BENEFIT FROM SWITCHING TO A SECOND BIOLOGIC DRUG WHEN THE FIRST IS WITHDRAWN DUE TO LACK OF EFFICACY OR ADVERSE EVENTS? E Hjardem 1 , M Østergaard 2 , ML Hetland 2 . 1 Department of Rheumatology, Hvidovre Hospital, 2 The Danish Database for Biological Therapies in Rheumatology (DANBIO), On Behalf of the DANBIO Study Group, Denmark Objective: To investigate the efficacy of a second biologic drug when the first has been withdrawn due to lack of efficacy or adverse events. Methods: Danish rheumatological patients (N 5 994, 65.3% women; age 15–88 (mean 53.6), disease duration 1–78 years (14.0), rheumatoid arthritis: 81%) receiving biological therapy (infliximab: 61%, etaner- cept: 21%, adalimumab: 16%) have been registered since autumn 2000. 116 patients switched biologic drug: 29 due to lack of efficacy (LAE- patients), 28 due to side effects (SE-patients) and 59 for unknown reasons. Clinical response was assessed by disease activity score at baseline (B-DAS) and DAS improvement compared to baseline (DAS- improvement). Results: B-DAS in all patients was mean 5.14 (SEM: 0.06). DAS-impr was after: 1.5 months: 1.59 (0.06), 6 months: 1.56 (0.08) and 12 months: 1.81 (0.10). All switching patients had a significant DAS-impr at six months at both first (1.22 (0,16) pv0.01) and second (1,13 (0,19) pv0.01) drug. LAE-patients (figure) had a significantly better response at six months to the second drug than to the first (pv0.01) whereas SE- patients (figure) and switchers of unknown reason (not shown) had similar responses to first and second drug. Conclusion: LAE-patients achieved a significantly better response to the second drug, whereas SE-patients achieved a similar response. It therefore seems worthwhile trying a second biologic drug. DO BONE EROSIONS, DETECTED BY MAGNETIC RESONANCE IMAGING AND ULTRASONOGRAPHY, REPRESENT TRUE EROSIVE CHANGES? A COMPARISON WITH COMPUTER TOMOGRAPHY IN RHEUMATOID ARTHRITIS METACARPOPHALANGEAL JOINTS UM Døhn 1 , BJ Ejbjerg 1 , M Court-Payen 2 , M Hasselquist 2 , M Szkudlarek 1 , JM Møller 2 , HS Thomsen 2 , M Østergaard 1,3 . 1 Department of Rheumatology, Hvidovre Hospitals, 2 Departments of Diagnostic Radiology and 3 Rheumatology, Herlev Hospital, Copenhagen University Hospitals, Denmark Objective: To determine the accuracy of magnetic resonance imag- ing (MRI) and ultrasonography (US) in the assessment of bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints, with multislice computer tomography (CT) as the reference method. Methods: In 17 RA patients, MRI, US, and CT of the second - fifth MCP joints were performed within one day. All patients were known to have a MRI erosion, which was not visible on X-ray, in at least one of the examined MCP joints. All imaging modalities were assessed for the presence of bone erosion in each MCP joint quadrant. Results: 272 quadrants were examined. CT detected erosions in 67, whereas MRI and US detected erosions in 64 and 46 quadrants, respectively. With CT as reference, MRI demonstrated a sensitivity of 67%, specificity of 91%, and accuracy of 85%. Corresponding measures for US was 48%, 93%, and 82%, respectively. Conclusion: With CT as the reference method, MRI and US demonstrated high specificities (91% and 93%) for detection of bone erosions in RA MCP joints. This study supports the notion that erosions detected by MRI and US represent true loss of calcified tissue, i.e. are true erosions. Scand J Rheumatol 2005;34:331–332 331 # 2005 Taylor & Francis on license from Scandinavian Rheumatology Research Foundation DOI: 10.1080/03009740510026328 www.scandjrheumatol.dk Scand J Rheumatol Downloaded from informahealthcare.com by Michigan University on 11/09/14 For personal use only.

Presentations at the annual spring meeting of The Danish Society for Rheumatology, Rungstedgaard, April 29–30, 2005

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Page 1: Presentations at the annual spring meeting of The Danish Society for Rheumatology, Rungstedgaard, April 29–30, 2005

ABSTRACTS

Presentations at the annual spring meeting of The Danish Societyfor Rheumatology, Rungstedgaard, April 29–30, 2005

DO PATIENTS BENEFIT FROM SWITCHING TO A SECOND

BIOLOGIC DRUG WHEN THE FIRST IS WITHDRAWN DUE TO

LACK OF EFFICACY OR ADVERSE EVENTS?

E Hjardem1, M Østergaard2, ML Hetland2. 1Department of

Rheumatology, Hvidovre Hospital, 2The Danish Database for

Biological Therapies in Rheumatology (DANBIO), On Behalf of the

DANBIO Study Group, Denmark

Objective: To investigate the efficacy of a second biologic drug when

the first has been withdrawn due to lack of efficacy or adverse events.

Methods: Danish rheumatological patients (N 5 994, 65.3% women;

age 15–88 (mean 53.6), disease duration 1–78 years (14.0), rheumatoid

arthritis: 81%) receiving biological therapy (infliximab: 61%, etaner-

cept: 21%, adalimumab: 16%) have been registered since autumn 2000.

116 patients switched biologic drug: 29 due to lack of efficacy (LAE-

patients), 28 due to side effects (SE-patients) and 59 for unknown

reasons. Clinical response was assessed by disease activity score at

baseline (B-DAS) and DAS improvement compared to baseline (DAS-

improvement).

Results: B-DAS in all patients was mean 5.14 (SEM: 0.06). DAS-impr

was after: 1.5 months: 1.59 (0.06), 6 months: 1.56 (0.08) and 12 months:

1.81 (0.10). All switching patients had a significant DAS-impr at six

months at both first (1.22 (0,16) pv0.01) and second (1,13 (0,19)

pv0.01) drug.

LAE-patients (figure) had a significantly better response at six

months to the second drug than to the first (pv0.01) whereas SE-

patients (figure) and switchers of unknown reason (not shown) had

similar responses to first and second drug.

Conclusion: LAE-patients achieved a significantly better response to the

second drug, whereas SE-patients achieved a similar response. It

therefore seems worthwhile trying a second biologic drug.

DO BONE EROSIONS, DETECTED BY MAGNETIC

RESONANCE IMAGING AND ULTRASONOGRAPHY,

REPRESENT TRUE EROSIVE CHANGES? A COMPARISON

WITH COMPUTER TOMOGRAPHY IN RHEUMATOID

ARTHRITIS METACARPOPHALANGEAL JOINTS

UM Døhn1, BJ Ejbjerg1, M Court-Payen2, M Hasselquist2, M

Szkudlarek1, JM Møller2, HS Thomsen2, M Østergaard1,3.1Department of Rheumatology, Hvidovre Hospitals, 2Departments

of Diagnostic Radiology and 3Rheumatology, Herlev Hospital,

Copenhagen University Hospitals, Denmark

Objective: To determine the accuracy of magnetic resonance imag-

ing (MRI) and ultrasonography (US) in the assessment of bone

erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP)

joints, with multislice computer tomography (CT) as the reference

method.

Methods: In 17 RA patients, MRI, US, and CT of the second - fifth

MCP joints were performed within one day. All patients were known to

have a MRI erosion, which was not visible on X-ray, in at least one of

the examined MCP joints. All imaging modalities were assessed for the

presence of bone erosion in each MCP joint quadrant.

Results: 272 quadrants were examined. CT detected erosions in 67,

whereas MRI and US detected erosions in 64 and 46 quadrants,

respectively. With CT as reference, MRI demonstrated a sensitivity of

67%, specificity of 91%, and accuracy of 85%. Corresponding measures

for US was 48%, 93%, and 82%, respectively.

Conclusion: With CT as the reference method, MRI and US

demonstrated high specificities (91% and 93%) for detection of bone

erosions in RA MCP joints. This study supports the notion that

erosions detected by MRI and US represent true loss of calcified tissue,

i.e. are true erosions.

Scand J Rheumatol 2005;34:331–332 331

# 2005 Taylor & Francis on license from Scandinavian Rheumatology Research Foundation

DOI: 10.1080/03009740510026328 www.scandjrheumatol.dk

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Page 2: Presentations at the annual spring meeting of The Danish Society for Rheumatology, Rungstedgaard, April 29–30, 2005

THE SMALLEST DETECTABLE DIFFERENCE AND

SENSITIVITY TO CHANGE OF MRI AND RADIOGRAPHIC

SCORES OF STRUCTURAL JOINT DAMAGE IN RHEUMATOID

ARTHRITIS FINGER, WRIST, AND TOE JOINTS – A

COMPARISON OF THE OMERACT RA MRI SCORE APPLIED

ON DIFFERENT JOINT COMBINATIONS AND THE SHARP/VAN

DER HEIJDE RADIOGRAPHIC SCORE.

BJ Ejbjerg1, A Vestergaard2, S Jacobsen3, HS Thomsen4, M

Østergaard1. Departments of 1Rheumatology and 2Diagnostic

Radiology, Hvidovre Hospital, 3Department of Rheumatology,

Rigshospitalet, 4Department of Diagnostic Radiology, Herlev

Hospital, Copenhagen University Hospitals, Denmark

Objective: To compare two MRI examination methods: ‘‘few-joints-

method’’ (unilateral wrist and MCP-joints) and ‘‘many-joints-method’’

(bilateral wrist and MCP-joints and unilateral MTP-joints) with the

purpose to clarify which methods that demonstrates the highest

sensitivity to change for structural joint damage and to compare the

findings with X-ray.

Methods: Follow-up study of 35 RA patients and nine controls. All

subjects were examined twice with a time gap of one year. MR-images

and X-ray were assessed according to the OMERACT-recommenda-

tions and the Sharp/van der Heijde method, respectively. The smallest

detectable differences (SDD) for MRI and X-ray were computed based

on re-evaluation of one third of the study population.

Results: MRI by the ‘‘few-joints-method’’ and the ‘‘many-joints-

method’’ revealed 25 and 30 subjects with erosive progression – one

subject had a decreased score by the ‘‘many-joints-method’’. X-ray

displayed nine subjects with erosive progression and four subjects with

decreased score. When only subjects with a change beyond the SDD

were considered, X-ray and MRI by the ‘‘few- and many-joints-

method’’ revealed 5, 12 and 15 subjects with erosive progression, while

no subjects displayed a decreased score by any of the methods.

Conclusion: MRI is, regardless of examination method, markedly

superior to X-ray with respect to detection of subjects with progressive

joint destruction.

WHAT IS A NORMAL ACHILLES TENDON ON ULTRASOUND?

DOPPLER BEFORE AND AFTER CONTRAST AGENT

MJ Koenig1, S Torp-Pedersen1, P Holmich2, M Bachmann Nielsen3, H

Bliddal1. 1The Parker Institute, Frederiksberg Hospital, 2Department

of Orthopaedic Surgery, Amager Hospital, 3Department of Radiology

and Ultrasonography X 4123, Rigshospitalet, Copenhagen, Denmark

Objective: Achilles tendonitis is typically seen on ultrasound (US) as a

thickened spindle-shaped tendon with disruption of the internal

architecture and Doppler activity. The latter seems closely linked to

disease activity and decreases or disappears when symptoms disappear.

With spectral Doppler, the type of flow is expressed with resistive

index (RI). Low RI values are associated with inflammation and a

value of 1.00 is normal.

When the vessels disappear, it is not possible to measure the RI and

it is assumed that the resistance has normalised. This study was

performed to test if normal tendinous vessels visualized with contrast

indeed had normal RI.

Methods: US was performed with a 14 MHz linear transducer. A

normal tendon was defined as a clearly demarcated tendon with

homogeneous fibrillar architecture, without spindle shape and without

Doppler activity.

Twenty-three asymptomatic tendons were scanned before 5 ultra-

sonically normal tendons in 5 subjects were identified.

In the five normal tendons contrast was used to bring vessels to

visualization.

Results: In the five ultrasonically normal tendons, arteries could be

detected with Doppler after contrast, in all cases with normal RI

values. All the vessels were located in the midportion of the tendon.

Eighteen tendons had US abnormalities on grey-scale examination

and all these cases all had Doppler activity in the abnormal area.

Conclusion: The majority of normal, healthy subjects had abnormalities

in the Achilles tendon on grey-scale US and in all these a detectable

intratendinous perfusion was present when examined with Doppler.

After injection of US contrast agent all 5 normal Achilles tendons

developed a detectable flow, which was normal in profile – RI 5 1.00.

Our US criteria seem too extensive since a majority of asymptomatic

and clinically normal subjects have abnormal tendons on US. We

believe there is a need for an age-stratified normal material.

WEIGHT LOSS REDUCE PAIN IN OBESE PATIENTS WITH

OSTEOARTHRITIS (OA) IN THE KNEE: LONG-TERM

RESULTS FROM A RANDOMISED TRIAL

R Christensen. The Parker Institute, Frederiksberg Hospital, Denmark

Objective: To determine the long-term efficacy of diet-induced weight

loss on pain in obese patients with knee OA.

Methods: 89 patients with knee OA were randomised to intensive-[I]

dietary treatment or control-[C], who only received dietetic counselling.

Demographics were 89% females; mean BMI was 36 (5) kg/m2 and age

63 (11) years. The outcome of interest was the differences in ‘WOMAC’

OA index [0–500mm]. Analyses: intention-to-treat (ITT), using PROC-

MIXED with the baseline-value as covariate.

Results: The I-group experienced a mean weight change of 210.9 kg

(11%) after 1 year intervention, in the C-group decrease was 23.3 kg

(3%) resulting in a difference between the weight losses in the groups:

7.6 kg (5.0 to 10.2 kg; Pv0.0001). There was an improvement in the

I-group of 238 mm (20%; Pv0.0001) and no change compared to

baseline in the C-group: 22 mm (1%; P 5 0.84); revealing a between-

group effect after 1 year: 36 mm (268 to 23 mm; P 5 0.031); effect-

size 5 0.5 (0.0–0.9). Independently of group, a cluster-analysis

(patients as clusters) demonstrated that 1% weight loss resulted in

3 mm (1.6%) improvement in the WOMAC-pain index (Pv0.0001).

Conclusion: In obese knee OA patients, who reduced their body weight,

an ITT population experienced a moderate clinical effect.

332 Abstracts

www.scandjrheumatol.dk

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