Background Ultrasound (US) (grey scale (GS) and power Doppler (PD)) is sensitive for scoring of synovitis in patients with rheumatoid arthritis (RA), with excellent reliability for semi-quantitative scoring (0-3) of GS and PD with an US atlas as reference. Thus it may be used for follow-up of patients with RA during biologic treatment. So far there is no consensus on the number of joints to be included.
Objectives To assess which are the most often involved joints in patients with established RA and the response of the different joints to biologic medication.
Methods 172 RA patients (aged mean (SD) 58 (12) years, disease duration 7 (5) years, 78% women, 82% anti-CCP positive) consecutively included when starting biologic treatment (infliximab (n=27); etanercept (n=54); adalimumab (n=20); certolizumab (n=10); golimumab (n=10); rituximab (n=29); tocilizumab (n=13); abatacept (n=9)) were examined by US (with the US atlas as reference) of 36 joints (wrist (radiocarpal, intercarpal, radioulnar), MCP 1-5, PIP 2 and 3, elbow, knee, talocrural, MTP 1-5). 81 patients were re-examined after 12 months. GS score ≥ 2 and PD score ≥ 1 were defined as inflamed joints. The mean percentage (of right/left involvement) for each joint was calculated.
Results At baseline the individual joints had GS score ≥ 2 in 12-41% and PD score ≥ 1 in 7-53% of patients. There was significantly reduced prevalence at 12 months follow-up for all joints (table). The median (range) differences in involvement of right vs left side of the individual joints were at baseline/follow-up 2(0-7)/ 5(0-9)% for GS and 3(0-7)/ 3(0-7)%, for PD. At baseline the radiocarpal and MCP 2 joints were most often involved (both GS synovitis and PD activity in ≥40% of patients).
Conclusions Bilateral examination of radiocarpal and MCP2 joints should be included in US assessments of RA patients. However, except for low prevalence of arthritis in knee and ankle joints, all the examined joints were frequently involved and could be candidates for US scoring. Thus, a comprehensive US assessment may be necessary to ensure a high sensitivity for detecting inflammation in follow-up of RA patients on biologic medication.
Disclosure of Interest None Declared
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