The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy

Abstract

PurposeTo determine the sensitivity to change of the US7 score among RA patients under various therapies and to analyze the effect of each therapeutic option over 1 year. To estimate predictors for development of destructive bone changes.MethodsMusculoskeletal ultrasound (US7 score), DAS28, CRP and ESR were performed in 432 RA patients at baseline and after 3, 6 and 12 months. The cohort was divided into four sub-groups: first-line DMARDs (Group 1; 27.3%), therapy switch: DMARDs to second DMARDs (Group 2; 25.0%), first-line biologic after DMARDs therapy (Group 3; 35.4%) and therapy change from biologic to second biologic (Group 4; 12.3%).ResultsThe US7 synovitis and tenosynovitis sum scores in grey-scale (GSUS) and power Doppler ultrasound (PDUS) as well as ESR, CRP decreased significantly (p<0.05) after 12 months in group 1 to 3. Group 1+2 also illustrated a significant change of DAS28 after 1 year (p<0.001). Only in Group 4, the US7 erosion sum score decreased significantly from 4.3 to 3.6 (p=0.008) after 1 year. Predictors capable of forecasting US erosions after one year were: higher score of US7 synovitis (p<0.001), of US7 erosions in GSUS (p<0.001), as well as of DAS28 (p<0.001) at baseline.ConclusionsThe comparable developments of the US7 score with clinical and laboratory data illustrates its potential to reflect therapeutic response. Therefore, the novel US7 score is sensitive to change. Patients who switched from one biologic to another exhibited a significant decline in erosions after 12 months, while the erosions scores in the other groups were stable.

The role of ultrasonography in assessing disease activity in patients with rheumatoid arthritis and associated fibromyalgia

“…Another study found that US synovitis score in 7 joints (US 7) was a better tool of assessing disease activity than composite disease activity scores in patients with RA and associated FM. The PD US7 score correlated with DAS28 only in patients without FM [17]. Our findings show small correlation coefficients between GS US and DAS28 and moderate for PD US and DAS28, suggesting that PD US could perform better in assessing disease activity in patients with RA and associated FM.…”

“…Wrists and MCP joints were examined in the longitudinal plane, from the dorsal aspect and PIP joints from the volar aspect to assess the presence of synovial fluid/ hypertrophy (GS) and synovial vascularisation (PD) (1 scan each joint). Compartment 6 of the dorsal wrist (extensor ulnari carpis tendon) and 1-5 finger flexor tendons were scanned for the detection of tenosynovitis (TS) in GS and PD US [17] in both hands. A total of 12 tendons were scanned for the detection of TS.…”

“…Semi-quantitative GS and PD scores (grade 0-3) were used for small joints [11], for large joints [12], and qualitative scores for GS TS (0-absent, 1-present) and semiquantitative (0-3) for PD TS [17]. A total score of (0-3) x 42 for GS and for PD, respectively and 0-12 for GS TS and (0-3) x 12 for PD TS, was calculated for each patient.…”

Concepts in monitoring the treatment in rheumatoid arthritis – the role of musculoskeletal ultrasound. Part I: synovitis.

“…Long term studies (>1 year) are few [113]. Statistical significance was obtained only at 30-38 weeks due to the low patients number included in the studies [117,118].…”

“…Currently, grade I synovitis is considered nonspecific for RA, being present in about 15% of the controls and without therapeutical relevance according to some authors opinion [114]. Indeed, a low PD grade associated to GS grade I may not necessarily reflect active synovitis [117]. On the contrary, according to a recent published study, GS grade I synovitis is not encountered in healthy subjects [122].…”