Background In the treatment of rheumatoid arthritis (RA), early diagnosis and tight control increased their importance in the era of biological therapy. Ultrasonography (US) of the various joints enables an evaluation of synovits and bone erosion in real time. It is proved to be useful to detect synovitis in the early stage of the disease. And it is useful for a comparison of the local disease activity at various stages.
Objectives The objectives of this study were to investigate whether the image of ultrasonography (US) at the operated joint reflect synovium pathology or clinical indicators, and to compare the results in the patient treated by non-biological agent (NonBio) and biological agent (Bio).
Methods RA related orthopaedic surgery was performed at 493 joints during the period betweeen January, 2011 and September, 2014. Preoperatively, US was performed and grade of Power Doppler (PD) signal was weighed. The evaluation including the Rooney score and Wakaki score of the synovium pathology organization that the synovium tissue collected at the time of the operation. DAS28-ESR(4), serum MMP-3, CRP were investigated. The sites of surgical operation were 8 shoulders, 64 knees, 47 elbows, 144 wrists, 17 ankles, 86 toes, 127 fingers. Number of the joints treated with Bio was 126 joints, and that with non-Bio was 367 joints. IFX was used in 20 patients, ETN in 42, TCZ in 30, ADA in 13, ABT in 9, GLM in 9, and CZP in 3.
Results The patients treated with Bio were significantly lower than those treated with non-Bio in PD signal of the operated joint (1.17±1.03, 1.59±0.98, p=7.06E-05), DAS28 (3.15±1.19, 3.82±1.08, p=1.12E-07), MMP-3 (116.2±120.0, 157.1±169.5, p=0.0034), Rooney score (24.13±8.49, 27.79±8.92, p=6.19E-08). The patients treated with TCZ were significantly lower than those treated with NonBio in PD signal (1.03±0.93, 1.59±0.98, p=0.0033), DAS28 (2.79±1.26, 3.82±1.08, p=0.0001). Rooney item score “fibrosis” in patients treated with IFX (9.30±1.49, p=0.001) and TCZ (9.03±1.97, p=0.001) were significantly higher than those in the patients treated with NonBio (7.89±1.90). “Synoviocyte hyperplasia” (1.17±1.12, 0.9±1.21), three items of lymphocytes: “perivascular infiltrates of lymphocytes” (1.35±2.70, 2.33±3.10),”focal aggregates of lymphocytes” (1.05±1.67, 1.67±2.28), “diffuse infiltrates of lymphocytes” (0.95±2.06, 1.37±2.09) in the patients treated with IFX or TCZ were lower than those treated with NonBio (1.99±1.39, p=0.0008, p=0.0005, 4.60±3.70, p=3.42E-05, p=0.0006, 3.74±3.25, p=4.29E-07, p=4.03E-05, 3.31±3.36, p=0.0001, p=3.60E-05).
Conclusions The activity of RA synovitis at the operated site was suppressed in the patients treated with Bio. Disease activity of RA was suppressed in the patients treated with Bio. There were some differences in clinical data, pathological score, PDS and DAS among Bio.
Disclosure of Interest None declared