Background Ultrasonography (US) detects grey scale synovitis (GS) and vascularization (by use of power Doppler (PD)) in patients with rheumatoid arthritis (RA). Rheumatoid Arthritis Impact of Disease (RAID) score is a patient developed new composite index including the following domains: pain, functional capacity, fatigue, physical and emotional wellbeing, quality of sleep and coping .
Objectives To explore longitudinally the associations between US pathology and RAID scores in RA patients starting anti-TNF therapy.
Methods Patients with RA starting anti-TNF treatment were consecutively included and examined at baseline and after 1, 2, 3 and 6 months with US of 36 joints and 4 tendons (wrist (radiocarpal, intercarpal and radioulnar), MCP 1-5, PIP 2 and 3, elbow, knee, ankle (talocrural), MTP 1-5 joints and extensor carpi ulnaris and posterior tibialis tendons bilaterally) (Siemens Antares; 5-13MHz probe, PRF 391Hz). GS and PD were scored semi-quantitatively (0-3), and sum scores from all joints and tendons were calculated. The clinical assessment included the RAID questionnaire, number of tender and swollen joints (of 28), assessor’s global VAS (study nurse) and ESR for calculation of DAS28. Paired samples T-test was used to explore significant changes from baseline, and associations were analyzed by use of Spearman’s rank correlations.
Results A total of 35 patients were included (mean (SD) age 52.6 (13.9) years, disease duration 6.6 (4.3) years, 78% anti-CCP positive and 86% women, using infliximab (n=13), etanercept (n=13), adalimumab (n=5) and golimumab (n=4). US (both sum score GS and PD), RAID and DAS28 improved significantly during follow-up (p<0.01 for all variables at all examinations) (table). For PDUS there were significant correlations with assessor’s global VAS at all examinations (r=0.36-0.57, p=0.04-0.001) as well as number of swollen joints (r=0.40-0.68, p=0.02-<0.001). RAID scores were, except for baseline, significantly correlated with assessor’s global VAS (r=0.40-0.63, p=0.04-<0.001) but had no significant associations with number of swollen joints. DAS28 was significantly associated with PDUS at baseline and after 3 and 6 months (r=0.44-0.56, p=0.02-0.002) and with RAID at all examinations (r=0.65-0.74, p<0.001). However, there were no significant correlations between sum GS or PD scores and RAID at any of the examinations, and not when each of the numeric rating scales for the seven domains were studied separately.
Conclusions In the present study US scores (both GS and PD), RAID and DAS28 improved during follow-up. However, the sum US synovitis scores were neither associated with the total RAID scores nor with any of the RAID questions. The RAID questionnaire captures information relevant to patients, and are thus of high clinical importance. However, the lack of association with US findings indicates that the two assessments examine different dimensions in the patients with RA.
Gossec L et al. Ann Rheum Dis 2011.
Disclosure of Interest None Declared