Background The use of ultrasonography (US) in RA is rapidly increasing. However, to our knowledge there have not been any studies directly comparing the prevalence and distribution of US joint inflammation in early and established RA.
Objectives To compare the prevalence, severity and distribution of grey-scale (GS) and power Doppler (PD) inflammation in two cohorts of patients with early and established RA, respectively.
Methods Between January 2010 and June 2013 patients were included in two cohorts – one consisting of DMARD-naïve patients with early RA according to 2010 ACR/EULAR classification criteria with indication for methotrexate, and the other of patients with established RA with indication for biologic DMARDs. An extensive US examination was performed by experienced sonographers using a validated GS and PD semi-quantitative scoring system with ranges 0-3 for GS and PD inflammation in 36 joints (Figure), and with an US image atlas as reference (1).
Results A total of 442 patients were included, 230 with early and 212 with established RA; 81.5% vs 82.0% anti CCP-positive, mean (SD) age 51 (14) vs 58 (12) years, DAS28 4.7 (1.2) vs 4.8 (1.4), median (25-75 percentile) 28-swollen joint count 6 (3-11) vs 5 (2-10), disease duration 0.5 (0.2-0.9) vs 7 (3-11) years, mean (95% CI) 36-joint US GS score 23 (21-25) vs 28 (25-30) (p=0.003), 36-joint US PD score 11 (10-12) vs 13 (11-15) (p=0.2). More than 15000 individual joints were assessed. The figure displays the prevalence of US GS and PD findings (scores ≥2) across the assessed joints in patients with early and established RA, respectively. MCP 2 had the highest frequency of PD ≥2 in both cohorts. The prevalence of GS and PD ≥2 was considerably higher in the established cohort for the MCP joints combined as well as for the radiocarpal joint.
Conclusions We could not find any major differences in the distribution of GS and PD US findings in early versus established RA, but the prevalence of joint inflammation was generally higher in the established cohort, although clinical disease activity was relatively similar. Patients with established RA had more GS and PD findings in the radiocarpal and MCP joints, whereas we observed a tendency towards more frequent involvement of the MTP 1-4 in early RA.
Ann Rheum Dis 2011 70:11 1995-8.
Disclosure of Interest A.-B. Aga: None declared, H. B. Hammer Grant/research support: AbbVie, Roche, Pfizer, I. C. Olsen: None declared, T. Uhlig: None declared, D. van der Heijde: None declared, T. K. Kvien Grant/research support: AbbVie, BMS, MSD/Schering-Plough, Pfizer/Wyeth, Roche, UCB, Consultant for: AbbVie, BMS, Celltrion, Eli Lilly, Hospira, MSD/Schering-Plough, Orion Pharma, Pfizer/Wyeth, Roche, UCB, E. A. Haavardsholm Grant/research support: AbbVie, Pfizer, MSD, Roche, USB