Can a Targeted Ultrasound Initiative Improve RA Outcomes?
Can a Targeted Ultrasound Initiative Improve RA Outcomes?
The first insight into a discrepancy between ultrasound findings and clinical composite indices of remission was from a study by Brown et al. The dominant wrists and 2nd–5th metacarpophalangeal joints of 102 patients using conventional DMARDs deemed in clinical remission (as determined by the treating rheumatologists) for least 6 months were scanned using both ultrasound and MRI. It demonstrated that, in at least one scanned joint, 74% and 43% of patients had GS or PD synovitis, respectively. This compared with the very small number of patients who had clinical synovitis. MRI confirmed the ultrasound findings but also highlighted an even higher number of patients with synovitis. More recent studies using ultrasound in different RA groups and scanning different sets of joints have confirmed similar findings.
In a subsequent study of 128 patients with RA (DAS<2.6; median <1.7) who were taking either DMARD or an antitumour necrosis factor (TNF) agent, ultrasound was performed on the dominant wrist and metacarpophalangeal joint 2–5. In patients fulfilling DAS28, modified ACR or SDAI remission criteria, moderate or severe PD activity was present in 21%, 15% and 19%, respectively. Although more stringent criteria reduced the number of swollen or tender joints, the number of joints with PD did not change.
How Do Clinical Criteria Compare With Ultrasound Criteria?
The first insight into a discrepancy between ultrasound findings and clinical composite indices of remission was from a study by Brown et al. The dominant wrists and 2nd–5th metacarpophalangeal joints of 102 patients using conventional DMARDs deemed in clinical remission (as determined by the treating rheumatologists) for least 6 months were scanned using both ultrasound and MRI. It demonstrated that, in at least one scanned joint, 74% and 43% of patients had GS or PD synovitis, respectively. This compared with the very small number of patients who had clinical synovitis. MRI confirmed the ultrasound findings but also highlighted an even higher number of patients with synovitis. More recent studies using ultrasound in different RA groups and scanning different sets of joints have confirmed similar findings.
In a subsequent study of 128 patients with RA (DAS<2.6; median <1.7) who were taking either DMARD or an antitumour necrosis factor (TNF) agent, ultrasound was performed on the dominant wrist and metacarpophalangeal joint 2–5. In patients fulfilling DAS28, modified ACR or SDAI remission criteria, moderate or severe PD activity was present in 21%, 15% and 19%, respectively. Although more stringent criteria reduced the number of swollen or tender joints, the number of joints with PD did not change.
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