Background Joint synovial inflammation is the primary abnormality in rheumatoid arthritis (RA) and monitoring of the response of synovitis to treatments has a fundamental importance in the management of RA patients. Power Doppler ultrasound (PDUS) has been demonstrated to be valid, reliable and sensitive-to-change in RA. However, its routine use in daily rheumatologic practice is often considered time-consuming, particularly in the assessment of the characteristic poly-articular involvement of the disease (1).
Objectives To monitor by PDUS the short term response to anti-TNFα therapy in 6 “target joints” of RA patients and to correlate PDUS findings with clinical and laboratory indexes of disease activity.
Methods Consecutive RA patients starting anti-TNFα therapy were included and studied at baseline and after 3 months of treatment. All patients were evaluated by PDUS at the level of 6 “target joints” (II MCP, wrist and knee bilaterally). The components of synovitis (synovial hypertrophy, joint effusion, PD signal) were analyzed and graded according to a 0-3 semi-quantitative score. In addition, by differently summing the PDUS findings, 3 different scores were calculated: a joint score (0-18; at II MCP, wrist and kneejoints), a single inflammatory lesion score (0-18; synovial hypertrophy, joint effusion, PD signal) and a global score at patient level (0-54; sum of all abnormalities). Finally, clinical (N° tender joints; N° swollen joints; VAS;DAS28) and laboratory (ESR; CRP) assessments were conducted. Wilcoxon and Spearman's tests were used for statistical analysis.
Results 68 RA patients (M/F 11/57; mean age 53.0±15.2 years, mean disease duration 143,6±41.0 months) treated with anti-TNFα therapy (45 etanercept, 23 adalimumab; 52 in combination with DMARDs) were included. A significant decrease of the joint score in all articular sites (MCP P=0.003; knee P=0.002; wrist P=0.0001) as well as of the scores of the single components of synovitis (P=0.0001-0.002) and of the global 6-joint score (P=0.0001) was found. In addition, all clinical and laboratory parameters were significantly decreased at follow-up (P=0.0001-0.001). Finally, a significant positive correlation was observed between the global PDUS score and DAS28 (r=0.38; P=0.001).
Conclusions PDUS is a sensitive-to-change imaging modality for the monitoring of short-term response to anti-TNFα treatment in RA patients. The assessment of the response to treatment in a limited number of joints makes the evaluation feasible in the daily rheumatologic practice as a complimentary tool to clinical assessment.
Perricone C, Ceccarelli F, Modesti M, Vavala C, Di Franco M, Valesini G, Iagnocco A. The 6-joint ultrasonographic assessment: a valid, sensitive-to-change and feasible method for evaluating joint inflammation in RA.Rheumatology (Oxford). 2012;51:866-73.
Disclosure of Interest None declared