Relationship Between Lymph Node Volume and Pain Following Certolizumab Therapy for Rheumatoid Arthritis Flare: A Pilot Study
Identifieur interne : 000B69 ( Main/Exploration ); précédent : 000B68; suivant : 000B70Relationship Between Lymph Node Volume and Pain Following Certolizumab Therapy for Rheumatoid Arthritis Flare: A Pilot Study
Auteurs : Homaira Rahimi [États-Unis] ; Gregory Dieudonne [États-Unis] ; Valeriy Kheyfits [États-Unis] ; Echoe M. Bouta [États-Unis] ; Ronald W. Wood [États-Unis] ; Rick Barrett [États-Unis] ; Sharon Moorehead [États-Unis] ; Edward M. Schwarz [États-Unis] ; Christopher T. Ritchlin [États-Unis]Source :
- Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders [ 1179-5441 ] ; 2016.
Abstract
The mechanisms that trigger flare in rheumatoid arthritis (RA) are unknown. In murine arthritis models, dysfunctional lymph node (LN) drainage is associated with joint flare. To examine if LN alterations are associated with RA flare, we analyzed the change in LN volume via contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with active joint flare at baseline and 16 weeks after certolizumab pegol (CZP) therapy. We also assessed the changes in popliteal or epitrochlear LN volumes versus the Rheumatoid and Arthritis Outcome Score (RAOS) (knee), or the Michigan Hand Questionnaire (MHQ; wrist/hand), and Disease Activity Score 28 (DAS28), at baseline and 16 weeks.
Total LN volume in 7 of 10 patients with measurable LN on CE-MRI significantly decreased 16 weeks after CZP therapy (mean decrease 37%;
RA patients with the smallest change in LN volume during anti-tumor necrosis factor (anti-TNF) therapy experienced the greatest pain relief in symptomatic knee joints. Moreover, the remarkably linear inverse correlation between LN volume and joint pain observed in this small clinical pilot provides initial evidence to support the concept that dynamic changes in draining LN volume are a biomarker of clinical response to therapy in RA.
Url:
DOI: 10.4137/CMAMD.S40237
PubMed: 28008295
PubMed Central: 5158121
Affiliations:
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<affiliation wicri:level="1"><nlm:aff id="af5-cmamd-9-2016-203">Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, USA.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">États-Unis</country>
<wicri:regionArea>Department of Orthopedics, University of Rochester Medical Center, Rochester, NY</wicri:regionArea>
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<author><name sortKey="Wood, Ronald W" sort="Wood, Ronald W" uniqKey="Wood R" first="Ronald W." last="Wood">Ronald W. Wood</name>
<affiliation wicri:level="1"><nlm:aff id="af6-cmamd-9-2016-203">Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">États-Unis</country>
<wicri:regionArea>Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY</wicri:regionArea>
<wicri:noRegion>NY</wicri:noRegion>
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<affiliation wicri:level="1"><nlm:aff id="af7-cmamd-9-2016-203">Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">États-Unis</country>
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<author><name sortKey="Moorehead, Sharon" sort="Moorehead, Sharon" uniqKey="Moorehead S" first="Sharon" last="Moorehead">Sharon Moorehead</name>
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<author><name sortKey="Schwarz, Edward M" sort="Schwarz, Edward M" uniqKey="Schwarz E" first="Edward M." last="Schwarz">Edward M. Schwarz</name>
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<affiliation wicri:level="1"><nlm:aff id="af5-cmamd-9-2016-203">Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, USA.</nlm:aff>
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<wicri:regionArea>Department of Orthopedics, University of Rochester Medical Center, Rochester, NY</wicri:regionArea>
<wicri:noRegion>NY</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="af7-cmamd-9-2016-203">Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.</nlm:aff>
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<wicri:regionArea>Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY</wicri:regionArea>
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<author><name sortKey="Ritchlin, Christopher T" sort="Ritchlin, Christopher T" uniqKey="Ritchlin C" first="Christopher T." last="Ritchlin">Christopher T. Ritchlin</name>
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<series><title level="j">Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders</title>
<idno type="eISSN">1179-5441</idno>
<imprint><date when="2016">2016</date>
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<front><div type="abstract" xml:lang="en"><sec><title>OBJECTIVES</title>
<p>The mechanisms that trigger flare in rheumatoid arthritis (RA) are unknown. In murine arthritis models, dysfunctional lymph node (LN) drainage is associated with joint flare. To examine if LN alterations are associated with RA flare, we analyzed the change in LN volume via contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with active joint flare at baseline and 16 weeks after certolizumab pegol (CZP) therapy. We also assessed the changes in popliteal or epitrochlear LN volumes versus the Rheumatoid and Arthritis Outcome Score (RAOS) (knee), or the Michigan Hand Questionnaire (MHQ; wrist/hand), and Disease Activity Score 28 (DAS28), at baseline and 16 weeks.</p>
</sec>
<sec><title>RESULTS</title>
<p>Total LN volume in 7 of 10 patients with measurable LN on CE-MRI significantly decreased 16 weeks after CZP therapy (mean decrease 37%; <italic>P</italic>
= 0.0019). Improvement in knee pain measured by the RAOS (<italic>P</italic>
= 0.03) inversely correlated with a decrease in total popliteal LN volume (<italic>R</italic>
<sup>2</sup>
= 0.94). All patients demonstrated significant improvement in DAS28 (mean decrease 1.48; <italic>P</italic>
= 0.0002). For flare in the hand, significant improvement in activities of daily living (ADL) as measured by the MHQ was observed (left hand mean improvement 20%; <italic>P</italic>
= 0.02; right hand mean improvement 37%; <italic>P</italic>
= 0.03).</p>
</sec>
<sec><title>CONCLUSION</title>
<p>RA patients with the smallest change in LN volume during anti-tumor necrosis factor (anti-TNF) therapy experienced the greatest pain relief in symptomatic knee joints. Moreover, the remarkably linear inverse correlation between LN volume and joint pain observed in this small clinical pilot provides initial evidence to support the concept that dynamic changes in draining LN volume are a biomarker of clinical response to therapy in RA.</p>
</sec>
</div>
</front>
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