Rheumatoid and psoriatic knee synovitis: clinical, grey scale, and power Doppler ultrasound assessment of the response to etanercept

Fiocco, Ugo; Ferro, Federica; Vezzù, Maristella; Cozzi, L.; Checchetto, Carlo; Sfriso, Paolo; Botsios, Costantino; Ciprian, Luca; Armellin, Gabriele; Nardacchione, Roberto; Piccoli, Antonio; Todesco, S; Rubaltelli, Léopoldo

doi:10.1136/ard.2004.025585

Cited by 124 publications

(71 citation statements)

References 37 publications

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“…The results of our study are supportive of those presented in other reports where US was used to monitor disease activity. We were able, however, to demonstrate this in a wider range of anatomical targets than in previous studies [28][29][30]. To our knowledge, this study represents the first attempt to investigate the effects of biologic therapy on multiple parameters in various joints affected by a chronic arthropathy.…”

Section: Discussionmentioning

confidence: 53%

“…More recently, 12 patients with RA and eight with psoriatic arthritis and knee synovitis treated with etanercept had a significant reduction in power Doppler signal which correlated with reductions in indices of disease activity including ESR and CRP. This improvement in synovitis was maintained for 12 months of biologic therapy and was confirmed by the reduction in thickness of the synovial membrane sonographically [30].…”

Section: Discussionmentioning

confidence: 64%

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Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

et al. 2007

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We evaluated clinically and sonographically the effects of etanercept therapy in patients with rheumatoid arthritis (RA) over 12 months of treatment. Eighteen patients affected by RAwho were non-responders or partial responders to disease modifying therapy were commenced on Etanercept treatment. Before starting therapy (T0) and at 12 months (T1), the following parameters were evaluated: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) for pain, number of painful and swollen joints, health assessment questionnaire (HAQ) and disease activity score in 28 joints (DAS 28). Musculoskeletal ultrasound (US) was performed in the following joints: second and fifth metacarpophalangeal, third interphalangeal, wrist and knee joints and a semiquantitative score (0-3) calculated and used to indicate the presence of a localised inflammatory process (synovitis, tenosynovitis, bursitis) and/or structural damage (bone erosion and cartilaginous change). An overall score was calculated based on the sum of the single scores to obtain a comprehensive score indicative of the global pathological change. The US global scores significantly reduced between T0 and T1 (p<0.0001). The following laboratory and clinical parameters also significantly reduced: ESR (p<0.0001), CRP (p<0.02), VAS (p<0.001), number of total swollen joints (p<0.001), number of total painful joints (p<0.01), HAQ scores (p<0.05) and DAS 28 (p< 0.0001). A positive response to treatment with Etanercept was demonstrated both by US examination of several joints and by clinical evaluation of several parameters. US is a useful tool in the monitoring of biologic therapy in RA, assessing both inflammatory and destructive changes.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 64%

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

et al. 2007

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“…Previously, the synovial thickness and power Doppler flow have been measured in the suprapatellar and parapatellar pouch (30), whereas the knee has been scanned in the suprapatellar and parapatellar planes by other investigators (31). In addition, synovitis of the knee has been scored in the suprapatellar longitudinal and transversal plane, and the diameter of the power Doppler signal and the resistance index have been determined (32).…”

Section: Discussionmentioning

confidence: 99%

Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

Hartung¹,

Kellner²,

Strunk³

et al. 2012

Arthritis Care & Research

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Objective. To introduce and evaluate a new standardized ultrasound (US) score developed for large joints in patients with rheumatoid arthritis (RA). Methods. A US score was designed to determine the degree of inflammation in the shoulder, the elbow, the hip, and the knee joint in patients with RA (Sonography of Large Joints in Rheumatology [SOLAR] score). Synovitis and synovial vascularity were scored semiquantitatively (grade 0 -3) by gray-scale US (GSUS) and power Doppler US (PDUS). Patients with RA were examined at baseline and 3, 6, and 12 months after initiation of local or systemic therapy (diseasemodifying antirheumatic drugs [DMARDs]/biologic agents). Erythrocyte sedimentation rate, anti-cyclic citrullinated peptide antibodies, and the clinical Disease Activity Score in 28 joints (DAS28) were determined. Results. A cohort of 199 patients were analyzed and followed up over 12 months. At baseline, before modification of the therapy, patients received either DMARDs (n ‫؍‬ 131), DMARDs plus biologic agents (n ‫؍‬ 46), biologic monotherapy (n ‫؍‬ 8), or no DMARD therapy (n ‫؍‬ 14). At baseline, the mean DAS28 score was 4.6 and decreased to 3.2 after 1 year of therapy (P < 0.001). All US scores demonstrated a statistically significant improvement except for the PDUS scores for the shoulder and the hip. In detail, the mean synovitis GSUS score for the knee decreased from 5.2 at baseline to 2.2 after 12 months of followup. The mean GSUS score for the shoulder fell from 2.6 to 1.6, for the elbow fell from 5.2 to 2.6, and for the hip fell from 2.2 to 0.4 (P < 0.05 for each). Conclusion. The SOLAR score is a feasible tool for the qualitative and quantitative evaluation of large joint involvement in patients with RA using US.

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“…Reports of several longitudinal studies (15,(17)(18)(19)(20)(21)(22)(23)) have described significant reduction of joint inflammation in RA as evaluated by gray-scale US, CDUS, or PDUS, after various durations of treatment with antitumor necrosis factor (anti-TNF), a therapy that has been widely demonstrated to be effective in RA (24)(25)(26). These studies have been conducted at individual research centers and have included a small number of patients and/or target joints (15,(17)(18)(19)(20)(21)(22)(23).…”

Section: Conclusion These Findings Indicate That Pdus Is a Valid Metmentioning

confidence: 99%

“…These studies have been conducted at individual research centers and have included a small number of patients and/or target joints (15,(17)(18)(19)(20)(21)(22)(23). Most of the previous studies have not evaluated the sensitivity to change of US parameters.…”

Section: Conclusion These Findings Indicate That Pdus Is a Valid Metmentioning

confidence: 99%

Power doppler ultrasonographic monitoring of response to anti–tumor necrosis factor therapy in patients with rheumatoid arthritis

Naredo

Möller²,

Cruz

et al. 2008

Arthritis & Rheumatism

237

151

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Objective. To evaluate the validity, responsiveness, and predictive value of power Doppler ultrasonography (PDUS) monitoring of response to tumor necrosis factor (TNF) blocking agents in rheumatoid arthritis (RA).Methods. Three hundred sixty-seven RA patients were prospectively recruited at 25 Spanish centers; complete clinical, laboratory, and PDUS data were obtained on 278 patients. The patients underwent clinical, laboratory, and PDUS assessment at baseline and after 1, 3, 6, and 12 months of anti-TNF treatment, and radiographic assessment of the hands and feet at baseline and 12 months. The Disease Activity Score in 28 joints (DAS28) was recorded at each visit. PDUS examination included 86 intraarticular and periarticular sites in 28 joints. US synovial fluid (SF), synovial hypertrophy (SH), and PD signal were scored in all synovial sites. US count and index for SF, SH, and PD signal were obtained. Sensitivity to change of the PDUS variables was assessed by estimating the smallest detectable difference (SDD) from the intraobserver variability.Results. A significant parallel improvement in DAS28 and PDUS parameters was found at followup assessment (P < 0.0005 for within-subject between-visit changes). The SDD for PDUS parameters was lower than the mean changes throughout followup. Timeintegrated values of US joint count for PD signal and rheumatoid factor (RF) showed predictive value in relation to progression of radiographic erosion (R ‫؍‬ 0.64), and time-integrated values of US joint count for PD signal, RF, and erythrocyte sedimentation rate were predictors of progression of the total radiographic score (R ‫؍‬ 0.59).Conclusion. These findings indicate that PDUS is a valid method for monitoring response to anti-TNF therapy in RA; results obtained by PDUS are reproducible and sensitive to change. PDUS findings may have predictive value in relation to radiologic outcome.

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Rheumatoid and psoriatic knee synovitis: clinical, grey scale, and power Doppler ultrasound assessment of the response to etanercept

Cited by 124 publications

References 37 publications

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

Power doppler ultrasonographic monitoring of response to anti–tumor necrosis factor therapy in patients with rheumatoid arthritis

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