Background The use of ultrasonography (US) for investigation and management of RA is rapidly increasing. However, to our knowledge there have not been any studies with systematical reporting of US findings in an inception cohort of RA patients according to the 2010 ACR/EULAR criteria.
Objectives To describe US findings and explore correlations between clinical and ultrasonographic synovial inflammation in an RA inception cohort.
Methods Consecutive patients who fulfilled the 2010 ACR/EULAR classification criteria for RA with symptom duration less than 2 years, and who were DMARD naïve with indication of DMARD treatment, were recruited from 11 centers in Norway between Oct 2010 and Dec 2012. An extensive US examination was performed by experienced sonographers using a validated gray-scale (BM) and power-Doppler (PD) semi-quantitative scoring system with ranges 0-3 for BM and PD in each of the following 36 joints: MCP I-V, radio-carpal (RCJ), distal radio-ulnar (DRUJ), inter-carpal (ICJ), PIP II-III, elbow, knee, talo-crural and MTP I-V bilaterally.
Results A total of 175 patients were included: 63.3% female, 79.7% anti-CCP pos, mean (SD) age 51.5 (13.1) years, DAS score 3.5 (1.1), patient global VAS (mm) 49.9 (23.6), median (25-75 percentile) disease duration 5 (2-10) months, ESR 21 (11-32) mm/hr, CRP 7 (3-18) mg/L, total Ritchie score 7 (4-13), 44-swollen joint count (SJC) 10 (4-15), US score 36-joint B-mode 18 (11-27), US score 36-joint power-Doppler 7 (3-14). Strong and statistically significant associations were observed between a 32-SJC comprising the same joints as assessed by US and 32-US BM (RCJ, DRUJ and ICJ combined into a single wrist score), and between 32-SJC and 32-US PD (Pearson corr. 0.62 and 0.61, respectively). Particularly when ≤5 joints were clinically swollen, US detected more active joints than clinical examination. A substantial proportion of joints that were clinically swollen were scored normal by US (28.2% by BM, 52.2% by PD), while 47.2% of joints with US findings were not clinically swollen (47.2% for BM, 31.4% for PD). Most of the US findings not associated with clinical swelling were grade 1. SJC, US-BM and US-PD were moderately correlated with CRP and ESR levels. Pattern of joint distribution and the most frequently affected joints are shown in the table. Table:Prevalence of US-PD, US-BM and clinical joint swelling (sorted by frequency of US PD findings)
Conclusions In this cohort of DMARD naïve early RA patients, a substantial correlation was found between ultrasonographic synovial inflammation (PD and BM) and clinical joint swelling, but there were discrepancies between clinical and US findings on the single joint level. The most affected joints by US-BM and US-PD were the wrist and MCP/MTP/PIP II-III. These findings suggest that US scanning provides a different estimate of inflammatory activity than clinical examination.
Disclosure of Interest A.-B. Aga: None Declared, E. Lie: None Declared, T. Uhlig: None Declared, H. Hammer: None Declared, D. van der Heijde: None Declared, T. Kvien: None Declared, E. Haavardsholm Grant/research support from: Abbvie, Pfizer, MSD, Roche, UCB
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.