Background Application of ultrasound (US) in the management of patients with rheumatoid arthritis (RA) is rapidly growing.
Objectives The randomized controlled ARCTIC trial (ClinicalTrials.gov NCT01205854) examined if the use of a treatment strategy based on structured US assessment1 would lead to improved outcomes in RA, compared to a conventional strategy based on clinical and laboratory assessments alone.
Methods Newly diagnosed DMARD naïve RA patients were randomized 1:1 to A) an ultrasound tight control (UTC) strategy targeting clinical and imaging remission (no ultrasound power-Doppler signal) or B) a conventional tight control (CTC) strategy targeting clinical remission. Patients in both arms were treated according to the same DMARD escalation strategy, starting with MTX, then triple therapy MTX/SSZ/HCQ, then biologic DMARD if target was not reached. The primary endpoint was the proportion of patients with a combination between 16 and 24 months of clinical remission, no swollen joints and non-progression of radiographic joint damage.
Results A total of 238 patients were randomized, and patients with at least one follow-up visit were included in the full analysis set (UTC n=118, CTC n=112). Twenty-six patients (22.0%) in the UTC arm and 21 patients (18.8%) in the CTC arm reached the primary endpoint (mean difference 3.3%; 95%CI -7.1% to 13.7%). No significant differences were found between the groups for the components of the primary outcome, and secondary endpoints were similar (table).
Conclusions The implementation and systematic use of ultrasound in the follow-up of early RA patients treated with an aggressive treat-to-target strategy is not justified based on the results of the ARCTIC trial.
Hammer HB et al Ann Rheum Dis 2011
Disclosure of Interest E. Haavardsholm Grant/research support from: Pfizer, MSD, UCB, AbbVie, Roche, A.-B. Aga: None declared, I. Olsen: None declared, S. Lillegraven: None declared, H. Hammer Consultant for: AbbVie, Pfizer, BMS, Roche, UCB, T. Uhlig: None declared, H. Fremstad: None declared, T. Madland: None declared, Å. Lexberg: None declared, H. Haukeland Consultant for: UCB, AbbVie, E. Rødevand: None declared, C. Høili: None declared, H. Stray: None declared, A. Bendvold: None declared, I. Hansen: None declared, G. Bakland Consultant for: AbbVie, Pfizer, L. Nordberg: None declared, D. Heijde: None declared, T. Kvien: None declared