Clinical Rheumatology

, Volume 26, Issue 6, pp 941–946 | Cite as

Rapid improvement in rheumatoid arthritis patients on combination of methotrexate and infliximab: clinical and magnetic resonance imaging evaluation

  • Lai-Shan TamEmail author
  • James F. Griffith
  • Alfred B. Yu
  • Tena K. Li
  • Edmund K. Li
Brief Report


The objectives of this study was to assess, using clinical and magnetic resonance imaging (MRI) criteria, the efficacy of combination infliximab therapy in patients with active rheumatoid arthritis (RA) refractory to methotrexate (MTX) treatment and to ascertain whether the changes in MRI parameters correlate with the clinical response. Four infusions of infliximab (3 mg/kg) at weeks 0, 2, 6, and 14 were added to a stable background dose of MTX in 19 patients with active disease. Clinical parameters were assessed before each infusion and at week 14. Dynamic contrast-enhanced MRI examination of the most severely affected wrist was performed at baseline and week 14. Synovitis severity, volume of synovitis, and synovial perfusion indices were evaluated. Significant improvement in all clinical disease activity parameters was seen at week 14 with reduction in C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and DAS28. Sixty-eight percent of patients achieved ACR20. MRI disease activity parameters also significantly decreased after treatment with reduction in grading of synovitis, volume of active synovitis, and perfusion enhancement slope. Significant positive correlations were seen between the baseline volume of synovitis and the pain score (r=0.65), patient global score (r=0.68), and health assessment questionnaire (HAQ) score (r=0.46). In conclusion, addition of infliximab to methotrexate rapidly reduces inflammation in longstanding patients with RA. Assessment of enhancing synovial volume and perfusion indices on serial MRI examination was helpful in documenting the effect of treatment over this short period.


Infliximab MRI Perfusion enhancement slope Rheumatoid arthritis Volume of active synovitis 



Infliximab was provided by Janssen Pharmaceutica, Hong Kong.


  1. 1.
    Lipsky PE, van der Heijde DM, St Clair EW et al (2000) Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N Engl J Med 343:1594–1602PubMedCrossRefGoogle Scholar
  2. 2.
    McQueen FM, Stewart N, Crabbe J et al (1999) Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 58:156–163PubMedCrossRefGoogle Scholar
  3. 3.
    Quinn MA, Conaghan PG, O’Connor PJ et al (2005) Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a 12-month randomized, double-blind, placebo-controlled trial. Arthritis Rheum 52:27–35PubMedCrossRefGoogle Scholar
  4. 4.
    Argyropoulou MI, Glatzouni A, Voulgari PV et al (2005) Magnetic resonance imaging quantification of hand synovitis in patients with rheumatoid arthritis treated with infliximab. Joint Bone Spine 72:557–561PubMedCrossRefGoogle Scholar
  5. 5.
    Zikou AK, Argyropoulou MI, Voulgari PV et al (2006) Magnetic resonance imaging quantification of hand synovitis in patients with rheumatoid arthritis treated with adalimumab. J Rheumatol 33:219–223PubMedGoogle Scholar
  6. 6.
    Ostergaard M, Duer A, Nielsen H et al (2005) Magnetic resonance imaging for accelerated assessment of drug effect and prediction of subsequent radiographic progression in rheumatoid arthritis: a study of patients receiving combined anakinra and methotrexate treatment. Ann Rheum Dis 64:1503–1506PubMedCrossRefGoogle Scholar
  7. 7.
    Ostergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386PubMedGoogle Scholar
  8. 8.
    Ostergaard M, Hansen M, Stoltenberg M et al (1999) Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 42:918–929PubMedCrossRefGoogle Scholar
  9. 9.
    Sugimoto H, Takeda A, Kano S (1998) Assessment of disease activity in rheumatoid arthritis using magnetic resonance imaging: quantification of pannus volume in the hands. Rheumatology 37:854–861CrossRefGoogle Scholar
  10. 10.
    Ostergaard M, Stoltenberg M, Lovgreen-Nielsen P et al (1998) Quantification of synovistis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation. Magn Reson Imaging 16:743–754PubMedCrossRefGoogle Scholar
  11. 11.
    Cimmino MA, Innocenti S, Livrone F et al (2003) Dynamic gadolinium-enhanced magnetic resonance imaging of the wrist in patients with rheumatoid arthritis can discriminate active from inactive disease. Arthritis Rheum 48:1207–1213PubMedCrossRefGoogle Scholar
  12. 12.
    Ostergaard M (1999) Magnetic resonance imaging in rheumatoid arthritis. Quantitative methods for assessment of the inflammatory process in peripheral joints. Dan Med Bull 46:313–344PubMedGoogle Scholar
  13. 13.
    Haavardsholm EA, Ostergaard M, Ejbjerg BJ et al (2005) Reliability and sensitivity to change of the OMERACT rheumatoid arthritis magnetic resonance imaging score in a multireader, longitudinal setting. Arthritis Rheum 52:3860–3867PubMedCrossRefGoogle Scholar
  14. 14.
    Maini R, Feldmann M (2002) How does infliximab work in rheumatoid arthritis? Arthritis Res 4(Suppl 2):S22–S28PubMedCrossRefGoogle Scholar
  15. 15.
    Cova M, Kang YS, Tsukamoto H et al (1991) Bone marrow perfusion evaluated with gadolinium-enhanced dynamic fast MR imaging in a dog model. Radiology 179:535–539PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2006

Authors and Affiliations

  • Lai-Shan Tam
    • 1
    Email author
  • James F. Griffith
    • 2
  • Alfred B. Yu
    • 2
  • Tena K. Li
    • 1
  • Edmund K. Li
    • 1
  1. 1.Department of Medicine and TherapeuticsThe Chinese University of Hong KongShatinPeople’s Republic of China
  2. 2.Department of Diagnostic Radiology and Organ ImagingThe Chinese University of Hong KongShatinPeople’s Republic of China

Personalised recommendations