Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse

Scirè, Carlo Alberto; Montecucco, Carlomaurizio; Codullo, Veronica; Epis, Oscar Massimiliano; Todoerti, Monica; Caporali, Roberto

doi:10.1093/rheumatology/kep171

Cited by 281 publications

(201 citation statements)

References 32 publications

(53 reference statements)

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“…In assessed RA, the PD signal was previously found to be associated with structural damage (21) and with disease change on treatment with DMARDs or tumor necrosis factor blockers (22)(23)(24). PD signal was also predictive of radiographic evidence of disease progression or relapse within 6 months in RA patients in clinical remission (25,26). Our study showed PD signal as an independent risk factor of rapid disease progression during the first year of early arthritis.…”

Section: Discussionsupporting

confidence: 66%

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

Funck‐Brentano

Gandjbakhch

Etchepare

et al. 2013

Arthritis Care & Research

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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.

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Section: Discussionsupporting

confidence: 66%

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

Funck‐Brentano

Gandjbakhch

Etchepare

et al. 2013

Arthritis Care & Research

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“…Persistent synovitis, especially in patients with early and very early RA, was proven to be present in patients being considered in clinical remission and was associated with a more unfavourable prognosis [15,22,26,32]. Analysing anti-RA33 titre, depending on US findings, we established statistically significant differences, between patients with/without active synovitis; thus, we found active synovitis only in 3 of the 15 patients with an anti-RA33 titre over the threshold value.…”

Section: Conflict Of Interest: Nonementioning

confidence: 65%

“…Setting an antibody profile, highly specific and sensitive, with a diagnostic and prognostic value, could be essential for assessing remission [1,[22][23][24][25][26]. Besides anti-CCP antibodies, present very early in the course of the disease, anti-RA33 antibodies can constitute an additional marker, not only for improving diagnosis, but also for assessing the prognosis and therapeutic response [5,27,28].…”

Section: Discussionmentioning

confidence: 99%

High frequency ultrasonography of the hand versus anti-RA33 evaluation in early rheumatoid arthritis - a pilot study

et al. 2017

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Aim: Accurate diagnosis and early treatment in rheumatoid arthritis (RA) can lead to a good outcome and a correct management of the disease. We aimed toinvestigate the prognostic value of anti-RA33 antibodies, by evaluating the relationship with ultrasonographic (US) findings in patients with early RA.Material and methods: We performed a prospective study which included 29 patients, diagnosed with early RA according to the ACR/EULAR 2010 criteria and 21 sex and age-matched control subjects. All patients underwent clinical and biological assessment, followed by US examination in grayscale (GS) and power Doppler (PD) at baseline and after 12 months [from the second to the fifth metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints and wrists (RCC), in dorsal aspect]. The second and fifth MCP joints were scanned also in lateral aspects.Results: The initial GS evaluation revealed the presence of synovitis in all 29 patients; PD found at least one joint with a PD grade higher than 1 in 23 patients, higher than 2 in 20 patients, and grade 3 in 6 patients; at 12 months, we revealed the presence of GSUS synovitis in 25 patients and PDUS examination found active synovitis in 12 subjects. In those patients, the anti-RA33 titre was significantly lower compared to those without PDUS active synovitis (p=0.031), with a moderately negative correlation (r=-0.519, p=0.0039).Conclusions: The current study shows that anti-RA33 antibodies might constitute an additional tool for diagnosing early RA patients and can help identify patients with mild disease and a low level of activesynovitis.

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“…Of 3004 studies identified initially, 14 articles were selected to be included in the review 8,9,14,25,26,27,28,29,30,31,32,33,34,35 . Table 1 shows the study design characteristics of the studies.…”

Section: Journal Of Rheumatologymentioning

confidence: 99%

A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter

Mandl

Naredo²,

Wakefield³

et al. 2011

J Rheumatol

183

108

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Objective. The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of synovitis in RA, a systematic analysis of the literature was performed. Methods. A systematic literature search of Pubmecl and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of synovitis. Results. Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination. Conclusions. Ultrasound can be regarded as a valuable tool for globally examining the extent of synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed. (J Rheumatol 2011; 38:2055-62; doi:10.3899/jrheum.110424

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Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse

Cited by 281 publications

References 32 publications

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

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

High frequency ultrasonography of the hand versus anti-RA33 evaluation in early rheumatoid arthritis - a pilot study

A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter

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