Background Rheumatoid arthritis (RA) – is a chronic inflammatory disease, which by natural course of the disease results in erosive polyarthritis, i.e. destruction and dysfunction of joints.
Objectives To investigate the relationship between ultrasonographic (US) evidence of “active” inflammation and radiographic progression in patients with RA and assess the potential of ultrasonographic imaging in evaluation of prognosis of patients with RA.
Methods The study included 83 patients with early RA (median age 54 [45;61] years. All patients were administered methotrexate (MTX) and/or biologic therapy in accordance with the treat-to-target concept (REMARCA study). Clinical and laboratory parameters were analyzed at baseline, in 12,24,36 and 48 weeks after initiation of therapy. Treatment efficacy was assessed using EULAR criteria and indices of activity. Ultrasound with gray scale (GS) and power Doppler (PD) were performed at baseline, 12,24,36 and 48 weeks after initiation of therapy. The wrist, MCP2, MCP3, PIP2, PIP3, MTP2 and MTP5 joints of the clinically dominant side were examined by US according to the European League Against Rheumatism (EULAR) guidelines. ESAOTE MyLabTwice and GE Logiq 9 US machines with 13–18 MHz-transducer were used. Plain X-rays were taken before treatment and at week 48 of therapy. Modified Sharp van der Heijde (SHS) scale was used to quantify the radiographic findings. Structural damage progression was evaluated based on changes in the SHS (ΔSHS) between baseline and 1 year.
Results At 48th weeks 56% patients had remission according to DAS28. The proportions of PD(+) and PD(−) patients were 47% and 53%, respectively. There was a correlation between ΔSHS by 48th week of treatment and PD at the 36 and 48th weeks (r=0,31 p=0,005;r=0,3 p=0,003 respectively) and GS at the 36th week (r=0,31 p=0,006). In patients, who had PD(+) synovitis at 48th week ΔSHS was significantly higher (r=0,01) as compared to patients without synovitis. Thus, in the group of PD(+) patients baseline radiological changes were more pronounced, than in patients without synovitis, but differences weren't statistically significant. The difference between the two groups of patients, based on the degree of radiological progression by 48th week of therapy, was significant for DAS28 at the 36th week: the DAS28 was higher in the group with radiological progression (r=0,004), while all other used clinical activity indices did not show any difference between the two groups. TJS and SJS were higher at the 12th week of therapy (r=0,04 and r=0,02, respectively), and CRP level at the 24th week was also higher in PD(+) group (r=0,03). PD synovitis score was higher at the 36 and 48th weeks (r=0,04 and r=0,000, respectively), and difference by GS synovitis score was established between the groups at the 36th week (r=0,02). Linear regression model revealed that GS synovitis score at week 24 correlated with ΔSHS during the first year of the therapy (OR=0,15, 95%CI: 0,023–0,207; p=0,015). The similar trend, though not significant, was noticed with PD synovitis score after 24 weeks of therapy (OR=0,104, 95%CI:-0,043–0,251; r=0,16).
Conclusions Thus, the analysis of annual structural damage progression confirmed that US (PD and GS synovitis) have prognostic value to predict future radiographic damage.
Disclosure of Interest None declared