NMR MONITORING OF RHEUMATOID-ARTHRITIS PATIENTS RECEIVING ANTI-TNF-ALPHA MONOCLONAL-ANTIBODY THERAPY

The aim of this study was to investigate if dynamic gadolinium-DTPA-su pported magnetic resonance (MR) imaging can monitor the therapeutic ef fect of a fast-acting immune-modulating drug like anti-tumour necrosis factor alpha (anti-TNF-alpha) monoclonal antibody (moab) in patients with rheumatoid arthritis (RA). Dynamic MR imaging was performed on 64 joints in a total of 18 patients before and after infusion with eithe r a placebo or 1 or 10 mg/kg of anti-TNF-alpha moab. Additionally, tre ating the placebo group and reinfusing the verum group with either 3 o r 10 mg/kg was monitored by quantitative nuclear magnetic resonance (N MR). Time-dependent signal intensity changes were then correlated with a total of five Paulus criteria and with ESR and C-reactive protein ( CRP). No changes in either the gadolinium uptake or clinical parameter s were seen after the infusion of a placebo. Therapy with 1 mg/kg anti -TNF-alpha moab resulted in a significant decrease in clinical disease activity, as well as in gadolinium-DTPA uptake in dynamic NMR studies . However, correlations between signal intensity changes and Paulus cr iteria were only demonstrated for the variable ''doctor's evaluation o f disease activity''. Patients given 10 mg/kg moab demonstrated a very significant improvement in all clinical manifestations of their disea se, as well as a high significant reduction in gadolinium uptake (P = 0.004). In addition, the latter group showed significant correlations between time-dependent signal intensity changes and five Paulus criter ia: ''number of swollen joints'', ''number of painful joints'', ''dura tion of morning stiffness'', ''doctor's evaluation of disease activity '' and ''patient's evaluation of disease activity''. No differences an d correlations were seen for ESR and CRP. We concluded that dynamic NM R studies are suitable to monitor inflammatory activity in RA patients under therapy with biological response modifiers such as anti-TNF-alp ha moab.