Importance of baseline musculoskeletal ultrasound findings in the prognosis of rheumatoid arthritis

Abstract

Objectives To investigate the prognostic value of baseline musculoskeletal ultrasound (MSUS) findings for rheumatoid arthritis (RA). Method We retrospectively analyzed 138 patients with RA. Patients’ first MSUS record was considered as the baseline expression. The subsequent MSUS changes that showed alleviation or progression were regarded as the cutoff point. Grayscale ultrasound (GSUS) synovitis, power Doppler ultrasound (PDUS) synovitis, PDUS tenosynovitis (TS), and bone erosion were scored using a semi-quantitative scale. According to the ultrasound (US) results of the cutoff point, patients were divided into the alleviation group and the progression group. Laboratory results (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], rheumatoid factor [RF], anticyclic citrullinated peptide [anti-CCP] antibody, and anti-keratin antibody [AKA]), disease activity score in 28 joints (DAS28)-ESR, and US scores were compared between the two groups to analyze the prognostic value of US findings in RA. Results The alleviation group had higher levels of CRP, synovitis, TS, GSUS synovitis, PDUS synovitis, PDUS TS, and US total scores at baseline than the progression group (p < 0.05). The alleviation group received more aggressive treatment in their initial approach than the progression group (p < 0.05). The frequency of US examinations in the alleviation group was more than that in the progression group at follow-up (p < 0.05). Presence of baseline synovitis (OR 0.248, p = 0.006) and a higher GSUS synovitis score (OR 0.521, p = 0.006) were negatively correlated with RA progression. Conclusions Presence of baseline synovitis and higher GSUS synovitis score do not always indicate worse prognosis of RA, which can be improved with aggressive treatment. Regular MSUS follow-up may have positive influences on prognosis. Key Points• The presence of synovitis at baseline and higher GSUS synovitis score do not necessarily imply poor prognosis of RA.• Prompt and powerful therapy and regular ultrasound follow-up can slow down the progression of RA and improve its prognosis.• Patients with slight and less arthritis at baseline might be ignored and get worse prognosis due to mild treatment strategies and irregular MSUS examination.

The prognostic value of 99mTc-glucosamine imaging in patients with rheumatoid arthritis: a single center prospective study

“…It has also been concluded that both RF and anti-CCP antibodies are clinically valuable biomarkers for the diagnosis and prognosis of patients with RA [18]. Today, of all the poor prognostic factors in patients with RA, RF and anti-CCP antibodies are among the most consistently relevant indicators of disease severity [4,6]. In our study, all patients with positive RF results also had positive anti-CCP antibody titers, implying that they more likely fell into the category of patients prone to early structural damage.…”

“…Other imaging modalities such as ultrasound (US) and MRI have also offered prognostic information in patients with RA by early identification of joints at risk of damage [5,6,26–29]. However, in their retrospective study of 138 patients, Sun et al .…”

“…However, in their retrospective study of 138 patients, Sun et al . concluded that a high gray scale synovitis score at baseline does not always indicate a worse prognosis of RA [6]. However, Ziegelasch et al .…”

“…This result may imply that grade 3 99m Tc-labeled glucosamine uptake might be associated with a worse prognosis in patients with RA. Other imaging modalities such as ultrasound (US) and MRI have also offered prognostic information in patients with RA by early identification of joints at risk of damage [5,6,[26][27][28][29]. However, in their retrospective study of 138 patients, Sun et al concluded that a high gray scale synovitis score at baseline does not always indicate a worse prognosis of RA [6].…”

“…Several clinical variables and biological markers, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF), constitute prognostic factors in RA [5]. In 2019, the European League Against Rheumatism (EULAR) established poor prognostic factors for RA, including persistently moderate or high disease activity despite therapy, high acute phase reactant levels, more swollen joint counts, high RF and/ or anti-cyclic citrullinated peptide (anti-CCP) antibody titers, and the presence of early bone erosion [6]. It has been reported before that high levels of CRP, RF and anti-CCP positivity are strongly associated with joint damage [4,6].…”