gms | German Medical Science

Background: To evaluate the association between intrasynovial hyperperfusion by means of power Doppler ultrasound (PDUS) and kinetics of serum vascular endothelial growth factor (VEGF) in patients with rheumatoid arthritis (RA) under treatment with TNF-α inhibitors.

Methods: 25 biological-DMARDS naive patients with RA (female: 18, male: 7, median disease duration: 9,2 years, ACPA positive: 20 patients) with an indication for a TNF-α inhibitor-treatment were examined by ultrasonography including PDUS before the initiation of TNF-α inhibitor-treatment and in week 4, 12 and 24 during treatment. The wrist, MCP II-V and PIP II-V of the dominant hand were examined by PDUS and the Doppler signal intensity was graded on a 4 step semiquantitative scale. Serum levels of VEGF were measured with a standard quantitative sandwich ELISA and disease activity was documented by means of DAS 28 Score (with C reactive protein, CRP) at each visit.

Results: Doppler signal intensity decreased 62% (p= 0,0001) from baseline. CRP (-60%; p=0,009) and DAS 28 (-32%) were also reduced significantly at visit 2. The range of initial VEGF was measured between 1161,5 pg/ml and 113,06 pg/ml. The VEGF Level was slightly dropped in the fourth week compared to baseline (-18%), but no further significant change of VEGF-Levels was observed until week 24 (p=0,24) (Figure 1 [Fig. 1]).

Conclusion: We observed a correlation between intra-articular perfusion and disease activity (p=0,00001). While synovial Doppler flow and CRP showed a significant reduction under TNF-α inhibiting-therapy, a crucial reduction of VEGF could not be determined. There was not an essential correlation between VEGF behavior and PDUS flow. The wide differences in the baseline VEGF levels could be discussed as a reason for the unexpected VEGF course in this group.