Ultrasound can be useful to predict an evolution towards rheumatoid arthritis in patients with inflammatory polyarthralgia without anticitrullinated antibodies

Zufferey, Pascal; Rebell, Claudia; Benaïm, Charles; Ziswiler, Hans‐Rudolf; Dumusc, Alexandre; So, Alexander

doi:10.1016/j.jbspin.2016.05.011

Cited by 31 publications

(33 citation statements)

References 21 publications

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“…A recent study conducted in healthy subjects described MSUS abnormalities in 88% of the population, 13% with synovial hypertrophy with or without Doppler signal,27 which underscores the limited specificity of MSUS joint abnormalities. The SONAR score used in this study has been validated in patients with RA,17 18 but has also been shown to be prognostic for the development of RA in patients with inflammatory arthralgias, with an OR of 7.4, independently of other prognostic factors 28. Currently several validated MSUS scoring systems exist, and it is not established which MSUS scoring system is most discriminant in preclinical stages of the disease.…”

Section: Discussionmentioning

confidence: 97%

Ultrasound is not associated with the presence of systemic autoimmunity or symptoms in individuals at risk for rheumatoid arthritis

et al. 2019

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ObjectiveTo identify whether musculoskeletal ultrasound (MSUS) abnormalities are associated with specific phases of rheumatoid arthritis (RA) development in individuals at risk of RA.MethodsThis is a prospective cohort study of individuals at risk of developing RA, namely first-degree relatives of patients with RA (RA-FDRs) without evidence of established rheumatic disease at inclusion. The inflammatory activity on MSUS was assessed according to a validated score (SONAR). Active MSUS was defined as a total B-mode score greater than 8, including at least one joint with significant synovitis (grade 2 or 3) or significant synovial hyperaemia (Doppler score greater than 1). We used logistic regression to analyse associations between MSUS findings and recognised preclinical phases of RA development, adjusting for other demographic and biological characteristics.ResultsA total of 273 RA-FDRs were analysed, of whom 23 (8%) were anticitrullinated protein autoantibodies-positive, 58 (21%) had unclassified arthritis and 96 (35%) had an active MSUS, which was only associated with unclassified arthritis (OR: 1.8, 95% CI 1.0 to 3.3).ConclusionIn individuals at risk of RA, active MSUS was associated with the presence of unclassified arthritis, but not with any of the earlier described phases of RA development. These findings do not support an indiscriminate use of ultrasound in a screening strategy for preclinical RA.

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Section: Discussionmentioning

confidence: 97%

Ultrasound is not associated with the presence of systemic autoimmunity or symptoms in individuals at risk for rheumatoid arthritis

et al. 2019

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“…The added value of US has been advocated at all levels of the disease stages4: from predicting diagnosis,1 to supporting the diagnostic and classification process,5 guiding treatment choices and response,6 predicting structural damage and flares,7 8 and influencing the concept and management of remission and treatment tapering 9 10. US has been shown to be superior to clinical assessment in detecting inflammation by assessing the presence of the most important elementary lesions in RA: synovial hypertrophy (SH), synovial effusion (SE) and Power Doppler activity (PD) 2.…”

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confidence: 99%

Back to the future: forget ultrasound and focus on clinical assessment in rheumatoid arthritis management

Caporali

Smolen

2017

Ann Rheum Dis

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Ultrasound (US) unquestionably improves many aspects of rheumatoid arthritis (RA) diagnosis and management, but no consensus has been reached regarding the optimal US methodology that should be used, and high levels of standardisation have not yet been attained. Current evidence from two randomised controlled trials does not support the US in directing treatment decisions. A return to the endorsement of clinical assessment and the adoption of T2T strategies aiming at ACR/EULAR remission still represent the standard of care for RA and should be pursued through appropriate educational programmes. Thus, for now, the major application of sonography in arthritis should have a focus on diagnostic and especially differential diagnostic aspects.

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“…Studies assessing the value of US have provided inconsistent results; some studies did not observe significant associations between US abnormalities and arthritis development, 27 43 44 while others did. 35 45 46 The studies that did not observe an association either included patients with seropositive arthralgia, ACPA-positive persons with non-specific MSK symptoms or patients with new-onset inflammatory arthralgia; studies that did observe an association included patients with arthralgia based on clinical characteristics, and differences in results might be partly explained by differences in patient selection. Furthermore, US protocols, joint regions assessed and US features reported on differed across the studies.…”

Section: The Predictive Accuracy Of Imaging Markers Detecting Subclinmentioning

confidence: 99%

Which patients presenting with arthralgia eventually develop rheumatoid arthritis? The current state of the art

2017

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Early initiation of treatment in patients with inflammatory arthritis at risk of persistence and/or erosive progression is important because it is associated with a reduced rate of progression of joint damage and functional disability. It has been proposed that a window of opportunity exists, during which disease processes are less matured and disease modification can be more effective. The phase of arthralgia preceding clinical arthritis is likely to be an important part of this window of opportunity, during which treatment might prevent progression to clinical arthritis. Several proof-of-concept trials in individuals with arthralgia are now evaluating this hypothesis. Central to such trials is the ability to identify groups at high risk of rheumatoid arthritis (RA) in whom preventive treatment can be tested. This review describes the relevance of adequate prediction making, as well as the accuracy of different types of predictors (including imaging and serological markers) with their value in predicting the progression of arthralgia to arthritis. Despite promising results, studies have been performed in heterogeneous patient populations and most findings have not been validated in independent studies. Future observational or preventive studies should be conducted with homogeneous patient groups (eg, patients fulfilling the European League Against Rheumatism criteria for arthralgia at risk of RA) in order to increase interstudy comparability and to allow result validation.

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Ultrasound can be useful to predict an evolution towards rheumatoid arthritis in patients with inflammatory polyarthralgia without anticitrullinated antibodies

Cited by 31 publications

References 21 publications

Ultrasound is not associated with the presence of systemic autoimmunity or symptoms in individuals at risk for rheumatoid arthritis

Ultrasound is not associated with the presence of systemic autoimmunity or symptoms in individuals at risk for rheumatoid arthritis

Back to the future: forget ultrasound and focus on clinical assessment in rheumatoid arthritis management

Which patients presenting with arthralgia eventually develop rheumatoid arthritis? The current state of the art

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