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The future of imaging in monitoring biologic therapy

Nature Clinical Practice Rheumatology volume 3, pages 2–3 (2007)Cite this article

The development of targeted biologic therapy for rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis has dramatically improved the treatment options for these diseases. Tumor necrosis factor inhibitors such as infliximab, adalimumab, and etanercept have been licensed for several years and are routinely used in clinical practice.

Before the development of biologic therapies, disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, were the mainstay of treatment for rheumatic diseases. The structural efficacy of DMARDs—their capacity to retard or prevent bone damage—has been monitored in the clinic using radiography. In patients with RA, for example, yearly hand and foot X-rays are used to identify the progression of erosions (cortical defects in bone), which are the pathologic hallmark of RA. Radiographic changes, however, take time to develop, and the 'window of opportunity'1 to treat these diseases early has closed by the time patients have developed structural damage visible on X-ray.

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References

  1. Emery P (1994) The optimal management of early rheumatoid disease: the key to preventing disability. Br J Rheumatol 33: 765–768

    Article  CAS  Google Scholar 

  2. American College of Rheumatology Extremity Magnetic Resonance Imaging Task Force (2006) Extremity magnetic resonance imaging in rheumatoid arthritis: report of the American College of Rheumatology Extremity Magnetic Resonance Imaging Task Force. Arthritis Rheum 54: 1034–1047

  3. Wakefield RJ et al. (2004) Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 63: 382–385

    Article  CAS  Google Scholar 

  4. Klauser A et al. (2005) Contrast enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group. Eur Radiol 15: 2404–2410

    Article  Google Scholar 

  5. Wakefield RJ et al. (2000) The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 43: 2762–2770

    Article  CAS  Google Scholar 

  6. McQueen FM et al. (2003) Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 48: 1814–1827

    Article  Google Scholar 

  7. Ostergaard M et al. (2003) New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier. Arthritis Rheum 48: 2128–2131

    Article  Google Scholar 

  8. Conaghan PG et al. (2003) Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum 48: 64–71

    Article  Google Scholar 

  9. Karim Z et al. (2004) Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis Rheum 50: 387–394

    Article  CAS  Google Scholar 

  10. Ostergaard M et al. (1997) Magnetic resonance imaging-determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis: comparison with the macroscopic and microscopic appearance of the synovium. Arthritis Rheum 40: 1856–1867

    Article  CAS  Google Scholar 

  11. Wakefield R et al. (2006) Anti-TNF induced remission in very early RA: A longitudinal study of imaging and clinical remission. Rheumatology 45 (Suppl 1): i50

    Google Scholar 

  12. Brown A et al.: RA patients in DMARD induced clinical remission still have significant synovitis: evidence from an imaging study may explain structural progression. Arthritis Rheum, in press

Download references

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  1. JE Freeston is a Specialist Registrar and P Emery is a Professor of Rheumatology and the Lead Clinician at the Leeds Teaching Hospital, Leeds, UK.,

    Jane E Freeston & Paul Emery

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  1. Jane E Freeston
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  2. Paul Emery
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Correspondence to Paul Emery.

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Freeston, J., Emery, P. The future of imaging in monitoring biologic therapy. Nat Rev Rheumatol 3, 2–3 (2007). https://doi.org/10.1038/ncprheum0381

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