Background TUI (Targeted Ultrasound Initiative) and TURA (Targeted Ultrasound Rheumatoid Arthritis), have been proposed as additional tools for managing and improving outcomes in rheumatoid arthritis (RA) (1), with the main objectives: education, research and training (2)
Objectives To evaluate the role of Targeted Ultrasound Initiative in the management of RA in Peru.
Methods With TUI TURA format has been developed in a training to 5 rheumatologists, with practices in 16 sessions, after 30 consecutive patients with a diagnosis of RA (ACR / EULAR, 2010), 12 with undifferentiated polyarthritis and 20 controls, all three regions of the country, who agreed to participate in the study, TUI TURA was applied for a period of six months (June to December 2012). The examinations were performed in 8 regions (shoulders, elbows, wrists, hands, knees, ankles and feet), performed with ultrasound Esaote, My Lab 25 Gold, with 10-18 MHz linear transducer, grayscale and power Doppler. Correlated with the DAS 28, HAQ, FR / AACP, clinical evaluation and radiographic study. With the results, the treatment decision was taken in each case and were followed quarterly AR in 15 cases.
Results 4 rheumatologists, after a period of four months, managed learning and optimal capacity for directed ultrasound leaf verified by the tutor and teacher evaluation to external (ultrasound group PANLAR/ EULAR). Average characteristics (intervals) of RA patients were age (years) 48 (18-61), disease duration (years): 3.5 (0.5 -14), DAS28 3.8 (1.2 - 5.8)) and HAQ: 2.6 (0.9 to 5.6). Of these, 68% had FR and 71% Positive AACP. In 25 of 30 patients with RA synovitis was observed in the study areas. 8 of 12 patients with undifferentiated polyarthritis were finally classified as AR, all early stage. In 6 of the 20 controls showed mild synovitis in the wrists, no clinical translation. In 78% of cases RA synovitis was observed (90%), tendinitis (33%) and / or bone erosion (56%), and 83% had Doppler signal power in at least one joint. In 60% of cases of RA, demonstrates aggressive and joint deterioration despite treatment with MTX, low doses of steroids and NSAIDs. In 18 patients was modified or added another DMARDS and 7 were selected to scale to biological therapy. Of the 15 patients, follow-up, 7 achieved partial remission and 8 are active.
Conclusions Following the proposal of TUI TURA can musculoskeletal ultrasound and joints, helps to clarify the diagnosis, especially in early stage disease, inflammation of the joints and tendons document, evaluate the aggressiveness and / or forecast illness, injury documentation damage (erosions and tendon rupture), directed by therapeutic decisions and monitor remission or failure to obtain the objectives, which can be filtered to a reasonable increase biologic therapy options. Multicenter longitudinal studies are needed to evaluate validity and use in daily practice.
Wakefield RJ, D’Agostino MA, Naredo E, et al. After treat-to-target: can a targeted ultrasound initiative improve RA outcomes? Ann Rheum Dis 2012;71:799-803
Brown AK, Roberts TE, O’Connor PJ, Wakefield RJ, Karim Z, Emery P. The development of an evidence-based educational framework to facilitate the training of competent rheumatologist ultrasonographers. Rheumatology 2007;46:391 7.
Disclosure of Interest None Declared