Conventional versus ultrasound treat to target: no difference in magnetic resonance imaging inflammation or joint damage over 2 years in early rheumatoid arthritis

Abstract

Objective To investigate whether an ultrasound-guided treat-to-target strategy for early RA would lead to reduced MRI inflammation or less structural damage progression compared with a conventional treat-to-target strategy. Methods A total of 230 DMARD-naïve early RA patients were randomized to an ultrasound tight control strategy targeting DAS <1.6, no swollen joints and no power Doppler signal in any joint or a conventional strategy targeting DAS <1.6 and no swollen joints. Patients in both arms were treated according to the same DMARD escalation strategy. MRI of the dominant hand was performed at six time points over 2 years and scored according to the OMERACT RA MRI scoring system. A total of 218 patients had baseline and one or more follow-up MRIs and were included in the analysis. The mean MRI score change from baseline to each follow-up and the 2 year risk for erosive progression were compared between arms. Results MRI bone marrow oedema, synovitis and tenosynovitis improved over the first year and was sustained during the second year of follow-up, with no statistically significant differences between the ultrasound and the conventional arms at any time point. The 2 year risk for progression of MRI erosions was similar in both treatment arms: ultrasound arm 39%, conventional arm 33% [relative risk 1.16 (95% CI 0.81, 1.66), P = 0.40]. Conclusion Incorporating ultrasound information in treatment decisions did not lead to reduced MRI inflammation or less structural damage compared with a conventional treatment strategy. The findings support that systematic use of ultrasound does not provide a benefit in the follow-up of patients with early RA. Trial registration number Clinicaltrials.gov, http://clinicaltrials.gov, NCT01205854.

Intermetatarsal Bursitis, a Novel Feature of Juxtaarticular Inflammation in Early Rheumatoid Arthritis Related to Clinical Signs: Results of a Longitudinal Magnetic Resonance Imaging Study

“…To determine this, we performed a large cross‐sectional MRI study. Finally, we hypothesized that IMB should also respond to treatment with disease‐modifying antirheumatic drugs (DMARDs), analogous to MRI inflammation measured by the RAMRIS ( 21 , 22 ). Follow‐up MRIs were evaluated to study this.…”

Treat to target: a winner strategy in rheumatology. From the past to the future

“…The strategy of using imaging methods to detect subclinical disease activity, unrecognized, is debated: the use of MRI is unfortunately unfavorable cost effectiveness, while ultrasound, more favorable cost effective, still offers mixed results. [6][7][8][9]…”

Are treat-to-target and dose tapering strategies for rheumatoid arthritis possible during the COVID-19 pandemic?

“…A face-to-face visit would include a physical examination, blood tests, and the recording of patient-reported outcomes. Although adding joint ultrasound examinations to treat-to-target methods does not appear to confer additional benefits compared with conventional treat-to-target strategies in a clinical trial setting, 5 the inclusion of ultrasound imaging in the face-to-face visit could help to achieve disease remission in real-world practice. Recognising that treat-to-target had not been uniformly adopted as standard practice in the era before COVID-19, despite increasing evidence of benefit, is important.…”