Correlation of ultrasonography synovitis with disease activity and clinical response to etanercept treatment in juvenile idiopathic arthritis patients

Abstract

This study aimed to investigate the correlation of ultrasonography (US) of synovitis with disease activity and clinical response to etanercept (ETN) in juvenile idiopathic arthritis (JIA) patients. Eighty-two JIA patients who underwent ETN treatment for 24 weeks were consecutively enrolled. US evaluations of 28 joints (shoulder, elbow, wrist, metacarpophalangeal, and proximal interphalangeal of hands and knee) at baseline were performed using grey-scale US and power doppler (PD) US, and US synovitis was defined as grey-scale abnormalities or PD abnormalities. Clinical response was assessed according to the ACRpedi 50 response criteria. In total, 2296 joints were scanned and 608 (26.5%) joints presented US synovitis, which was numerically higher than clinical synovitis (513 (22.3%)). The mean number of joints showing synovitis on US was 7.42±3.35, which was also numerically higher than that of clinical synovitis (6.26±2.70). The number of joints showing synovitis on US was positively correlated with C-reactive protein, erythrocyte sedimentation rate, number of joints with active disease, number of joints with limited range of motion, physician's global assessment of disease activity, parent/patient global assessment of overall well-being, and childhood health assessment questionnaire score. Most interestingly, the baseline number of joints showing synovitis on US was increased in ACRpedi 50 response JIA patients compared to non-response JIA patients, and it serves as an independent predictive factor for higher clinical response to ETN treatment. In conclusion, US is a more sensitive test to evaluate subclinical synovitis and disease activity in JIA patients, and US synovitis might serve as a marker for predicting increased clinical response rate to ETN treatment.

JNK Pathway-Associated Phosphatase as a Serum Marker for Disease Activity and Treatment Outcome of Juvenile Idiopathic Arthritis

“…Besides, the combinations of other disease-related drugs (such as methotrexate (MTX), leflunomide (LEF) and other disease-modifying antirheumatic drugs (DMARDs)) were allowed, and the related information was documented. After 24 weeks of ETN treatment, the clinical response was assessed referring to the American College of Rheumatology (ACR) Pediatric (pedi) 50 criteria: 50% improvement from baseline in at least 3 of any 6 measures of the JIA core sets without more than 1 measure worsening by over 30% (Consolaro et al 2009;Zhou and Gu 2019). The 6 measures were erythrocyte sedimentation rate (ESR), joints with active arthritis, joints with limited range of motion, physician's global assessment of disease activity, parent/patient global assessment of overall well-being and CHAQ scores.…”

The Epidemiological Profile of Juvenile Idiopathic Arthritis: Single Center Study in Delta Region of Egypt

“…Furthermore, Zhou and Gu, 2019 (55) showed that the number of joints showing synovitis at baseline was positively correlated with CRP, ESR, number of joints with active disease.…”

Biomarkers of Response to Biologic Therapy in Juvenile Idiopathic Arthritis

“…Another prospective study reported that the number of ultrasound positive joints (out of 28) decreased significantly after 24 weeks treatment with etanercept. The same study concluded that a higher number of ultrasound positive joints at baseline was seen in patients who achieved ACRPedi50 response compared to patients who did not, and that it was an independent predictive factor of response (odds ratio – OR = 1.438, 95% CI: 1.091–1.897) ( Zhou and Gu, 2019 ). On the other hand, there are conflicting results as to whether positive ultrasound findings in JIA patients with inactive disease can predict flares, although it should be noted that a minority of patients were on biologic treatment in these studies ( Magni-Manzoni et al, 2013 ; Miotto et al, 2017 ; De Lucia et al, 2018 ; Zhao et al, 2018 ).…”