Rheumatoid Arthritis: Louie J

Anderson P, Louie J, Lau A, Broder M. · Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. · Curr Rheumatol Rep. · Pubmed #15760575 No free full text.

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Mundwiler ML, Maranian P, Brown DH, Silverman JM, Wallace D, Khanna D, Louie J, Furst DE, Weisman MH. · North Suburban Rheumatologists, Des Plaines, IL 60016, USA. · Arthritis Res Ther. · Pubmed #19545417 links to  free full text

Abstract: INTRODUCTION: Magnetic resonance imaging (MRI) may reveal rheumatoid arthritis (RA) changes in the feet when hands are normal. The purpose of this study was to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a metatarsophalangeal (MTP) erosion on MRI to predict a subsequent radiographic erosion in the same joint. Similar analyses were performed for bone marrow edema, predicting a subsequent MRI erosion. Descriptive results of other lesions are reported. METHODS: Fifty patients with RA of less than 5 years' duration who were rheumatoid factor-positive and/or anti-cyclic citrullinated peptide-positive were recruited. Patients on anti-tumor necrosis factor (TNF) therapy were excluded. Anti-TNF therapy could begin after enrollment. MRI and radiographs of the 3rd, 4th, and 5th MTP joints bilaterally were taken at baseline and at 6, 12, and 24 months. Clinical data were collected. RESULTS: Fifty patients were recruited; 46 patients had suitable data. Results for MRI erosions predicting subsequent radiographic erosions for 6, 12, and 24 months, respectively, were as follows: sensitivity 0.75, 0.60, 0.75; specificity 0.93, 0.94, 0.94; PPV 0.086, 0.10, 0.17; NPV 0.998, 0.995, 0.995. Results for MRI bone marrow edema predicting MRI erosions at 6 and 12 months, respectively, revealed sensitivity 0.50, 0.67; specificity 0.97, 0.97; PPV 0.25, 0.50; NPV 0.99, 0.99. Synovitis was the most common finding and, when present in isolation, resolved on 67.3% of subsequent studies. MRI erosions persisted on subsequent studies with one exception. Forty-six percent of the cohort was on anti-TNF therapy after study inception. CONCLUSIONS: The PPV of MRI erosions to predict subsequent radiographic erosions was low. Similarly, the PPV of bone marrow edema to predict a later MRI erosion was low. Alternatively, the NPV of the absence of an MRI erosion or bone marrow edema predicts that a later radiographic erosion or MRI erosion will likely not develop. Anti-TNF therapies may have resulted in the lower-than-anticipated PPVs. MRI descriptions of bone edema may represent a more critical time to treat in order to avoid damage, whereas an MRI erosion represents more permanent damage. This study suggests that imaging modalities more sensitive than radiographs are necessary to monitor disease in the biologic era.

Weinblatt ME, Schiff MH, Ruderman EM, Bingham CO, Li J, Louie J, Furst DE. · Rheumatology and Immunology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. · Arthritis Rheum. · Pubmed #18576334 links to  free full text

Abstract: OBJECTIVE: To evaluate the efficacy and safety of treatment with 50 mg of etanercept twice a week plus weekly methotrexate (MTX; > or =15 mg) in patients with rheumatoid arthritis (RA) who had a suboptimal response to 50 mg of etanercept once a week plus weekly MTX (> or =15 mg). METHODS: In this multicenter, randomized, double-blind, active drug-controlled study, suboptimal responders to treatment with MTX plus etanercept 50 mg once weekly were given MTX plus etanercept 50 mg twice weekly (n = 160) or MTX plus etanercept 50 mg once weekly plus a placebo (n = 40) for 12 weeks. In a subsequent 12-week open-label period, patients who responded to etanercept 50 mg twice weekly decreased their dosage to 50 mg once weekly, those who had a partial response to etanercept 50 mg once weekly increased their dosage to 50 mg twice weekly, and those who had no response to etanercept 50 mg twice weekly were discontinued. The primary end point was the proportion of patients with a response on the Disease Activity Score 28-joint assessment (DAS28) at week 12. RESULTS: A total of 201 patients were randomized; 187 completed 12 weeks, and 102 completed 24 weeks. At week 12 (double-blind period), the DAS28 response in the 50 mg twice weekly and the 50 mg once weekly groups was not significantly different (45.6% versus 35.0%; P = 0.285), and similar proportions of patients in the groups taking 100 mg and 50 mg experienced adverse events (34.4% versus 37.5%; P = 0.711). Serious adverse events occurred in 7 of 160 of the 50 mg twice weekly group and 0 of 40 of the 50 mg once weekly group (P = 0.387), and serious infectious events occurred in 3 of 160 patients in the 50 mg twice weekly group (P = 0.884). CONCLUSION: Etanercept 50 mg once weekly is an optimal dosage in most patients with RA. Increasing the dosage from 50 mg once weekly to 50 mg twice weekly in suboptimal responders did not significantly improve their DAS28 responses.