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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BIOLOGIC DRUG WHEN THE FIRST IS WITHDRAWN DUE TO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the first has been withdrawn due to lack of efficacy or adverse events.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
Scan
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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
Scan
d J
Rhe
umat
ol D
ownl
oade
d fr
om in
form
ahea
lthca
re.c
om b
y M
ichi
gan
Uni
vers
ity o
n 11
/09/
14Fo
r pe
rson
al u
se o
nly.