Ann Rheum Dis doi:10.1136/annrheumdis-2011-201048
  • Review

After treat-to-target: can a targeted ultrasound initiative improve RA outcomes?

  1. Paul Emery12
  1. 1Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine LIMM, University of Leeds, Leeds, UK
  2. 2Leeds NIHR Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3APHP Hôpital Ambroise Paré, Service de Rheumatologie, Boulogne- Billancourt, & Université Versailles St-Quentin, Paris, France
  4. 4Hospital Universitario Gregorio Marañon, Madrid, Spain
  5. 5Dipartimento di Medicina Interna e Specialita Mediche, Sapienza Universita di Roma, Roma, Italy
  6. 6Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
  7. 7Department of Rheumatology and Clinical Immunology, Charité – University Medicine Berlin, Germany
  8. 8Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy.
  9. 9Rheumatology B department, René Descartes University and APHP, Cochin Hospital, Paris,France
  10. 10Hospital Universitario la Paz, Madrid, Spain
  11. 11Academic Rheumatology Unit, Aintree University Hospital, Liverpool, UK
  12. 12Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
  13. 13National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  1. Correspondence to Professor Emery, NIHR/LMBRU Director, LIMM Division of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK; p.emery{at}
  1. Contributors All the authors are members of the are members of the TUI group project. All the authors contributed to the conception and drafting of the article.

  • Accepted 25 February 2012
  • Published Online First 5 May 2012


For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network - the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA.


  • Competing interests TUI is an educational programme funded by Abbott Laboratories and GE.

    TURA is supported by Abbott

  • Provenance and peer review Not commissioned; externally peer reviewed.

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