Prediction of Radiographic Damage in Early Arthritis by Sonographic Erosions and Power Doppler Signal: A Longitudinal Observational Study

Abstract

Objective. To assess the ability of ultrasonography (US) to predict radiographic damage in early arthritis. Methods. ESPOIR is a multicentric cohort of early arthritis (i.e., >2 swollen joints between 6 weeks and 6 months). US synovitis in B mode, power Doppler (PD) mode, and erosions were searched on the second through the fifth metacarpophalangeal and fifth metatarsophalangeal joints according to Outcome Measures in Rheumatology definitions. Structural radiographic progression was assessed using the modified Sharp/van der Heijde erosion score (SHS) at baseline and 1 and 2 years. Predictive factors of erosive arthritis at 2 years and rapid radiographic progression (RRP) at 1 year (defined by change of SHS >5) were searched. Results. A total of 127 patients were included, with a mean ؎ SD Disease Activity Score in 28 joints of 5.1 ؎ 1.3; 37.6% were anti-citrullinated protein antibody positive and 27.6% had typical rheumatoid arthritis (RA) erosions on radiographs. At 2 years, 42 patients (39.2%) had typical RA erosions. US erosions predicted radiographic evidence of erosive arthritis (odds ratio [OR] 1.44, 95% confidence interval [95% CI] 1.04 -1.98). PD synovitis score was predictive of RRP at 1 year (OR 1.22, 95% CI 1.04 -1.42). US erosions and PD synovitis scores were associated with change of SHS on linear regression. Of the 1,184 analyzed joints, 105 (8.9%) had radiographic erosion at 1 year. At the joint level, baseline US erosions were predictive of the presence of radiographic erosions at 1 year (P < 0.001). The same trend was observed in the joints without radiographic erosions at baseline (P ‫؍‬ 0.052). Conclusion. US is useful to evaluate the potential severity of early arthritis: US erosions and PD-positive synovitis have prognostic value to predict future radiographic damage.

A comparative study between ultrasonographic hand features in systemic sclerosis and rheumatoid arthritis patients: Relation to disease activity, clinical and radiological findings

“…In RA patients we found a significant correlation between US detected synovitis and the DAS28, ESR and CRP. In contrast, other studies found that many RA patients who are regarded as having clinically inactive disease still exhibit evidence of persistent synovitis on US scanning [7] that appears predictive of worse outcomes [4]. However, other studies suggested that radiographic progression of patients in remission is largely restricted to those who continue to exhibit clinical evidence of joint inflammation (SJC P 2), since patients with an SJC 6 1 or in sustained remission had minimal disease progression [39,40].…”

“…The presence of synovitis detected by MSUS is useful in the diagnosis of undifferentiated arthritis (UA) [2] and in inflammatory arthritis it is predictive of persistent disease [3], joint damage [4], and acute disease flare [5]. It has dramatically improved joint and tendon evaluation in rheumatoid arthritis (RA) and other inflammatory diseases [6].…”

Joint Ultrasonography in Rheumatoid Arthritis: Pathogenetic Rationale, Possible Use in Diagnosis, Therapy Efficiency Evaluation, and Outcome Prediction

“…Одну из таких работ выполнили T. Funck-Brentano и соавт. [63], которые обследовали 127 пациентов с ранним артри-том. В течение 2 лет наблюдения было показано, что ЭД позволяет прогнозировать рентгенологическое прогресси-рование.…”

Longitudinal study of clinical prognostic factors in patients with early rheumatoid arthritis: the PREDICT study

“…22 Magnetic resonance imaging and power Doppler ultrasound are increasingly being used to detect inflammation and bone injury, and allow management of RA before progression becomes detectable on X-ray. [23][24][25] They may also have prognostic value in aggressive disease, 23 but at this stage their predictive utility value is modest at best, and their lack of availability means their applicability in clinical practice is limited at this time.…”