Value of ultrasonography as a marker of early response to abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: results from the APPRAISE study

D'Agostino, Maria Antonietta; Wakefield, Richard J.; Berner-Hammer, Hilde; Vittecoq, Olivier; Filippou, Georgios; Bálint, Péter; Möller, Ingrid; Iagnocco, Annamaria; Naredo, Esperanza; Østergaard, Mikkel; Boers, Maarten; Gaillez, Corine; Holder, Karina Van; Bars, Manuela Le

doi:10.1136/annrheumdis-2015-207709

Cited by 83 publications

(70 citation statements)

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“…7 APPRAISE was the first prospective, multicentre, international study to use this composite PDUS score at joint and patient levels to measure the early signs of response to treatment with abatacept in biological-naïve adult patients with active RA despite methotrexate (MTX) therapy. 8 This study demonstrated the responsiveness of the composite PDUS GLOESS when applied at a patient level, showing the rapid onset of action of abatacept, independently of the number of joints examined. The responsiveness of GLOESS equalled that of clinical assessment by Disease Activity Score (DAS)28 C reactive protein (CRP).…”

Section: Key Messagesmentioning

confidence: 56%

Exploring a new ultrasound score as a clinical predictive tool in patients with rheumatoid arthritis starting abatacept: results from the APPRAISE study

et al. 2016

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ObjectivesTo explore whether changes in a composite (power Doppler/greyscale ultrasound (PDUS)) synovitis score, developed by the OMERACT-EULAR-Ultrasound Task Force, predict disease activity outcomes in rheumatoid arthritis (RA).MethodsPatients with RA who were methotrexate inadequate responders starting abatacept were evaluated. Individual joint PDUS scores were combined in the Global OMERACT-EULAR Synovitis Score (GLOESS) for metacarpophalangeal joints (MCPs) 2–5, all joints (22 paired) and a reduced (9 paired) joint set. The predictive value of changes in GLOESS at week 1–16 evaluations for clinical status and response (Disease Activity Score (DAS)28 (C reactive protein, CRP) <2.6; DAS28(CRP) ≤3.2; DAS28(CRP) ≥1.2 improvement) up to week 24, and correlations between DAS28 and GLOESS were assessed.ResultsEighty-nine patients completed the 24-week treatment period. Changes in GLOESS (MCPs 2–5) from weeks 1 to 16 were unable to predict DAS28 outcomes up to week 24. However, significant improvements in GLOESS (MCPs 2–5) were observed at week 12 in patients with DAS28 ≥1.2 improvement at week 24 versus those who did not achieve that clinical response. In patients achieving DAS28 ≥1.2 improvement or DAS28 ≤3.2 at week 24, changes in GLOESS (22 and 9 paired joint sets) were greater in patients who already achieved DAS28 ≥1.2 at week 12 than in those who did not. No significant correlations were found between changes in DAS28 and GLOESS definitions at any time point.ConclusionsPDUS was not correlated with clinical status or response as measured by DAS28-derived criteria, and PDUS changes were not predictive of clinical outcome. The discrepancies require further exploration.Trial registration numberNCT00767325; Results.

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Section: Key Messagesmentioning

confidence: 56%

Exploring a new ultrasound score as a clinical predictive tool in patients with rheumatoid arthritis starting abatacept: results from the APPRAISE study

et al. 2016

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“…Both GS and Doppler are at least as sensitive as clinical examination and laboratory markers in detecting changes in patients with RA who have initiated effective therapy 60. The more comprehensive the US examination, the more sensitive it is in detecting change 51.…”

Section: Resultsmentioning

confidence: 99%

“…The more comprehensive the US examination, the more sensitive it is in detecting change 51. However, reduced-joint US assessments have also shown a good sensitivity,47 48 55 60 61 focusing either on a few target joints such as the wrist, metacarpophalangeal and metatarsophalangeal joints or on a few small joints plus one or two large joints 47 48 55 60 62…”

Section: Resultsmentioning

confidence: 99%

Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission

D'Agostino¹,

Terslev

Wakefield

et al. 2016

Ann Rheum Dis

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The absence of specific guidance on how to use US to diagnose and manage patients with inflammatory arthritis, especially with rheumatoid arthritis (RA) has hindered the optimal utilisation of ultrasound (US) in clinical practice, potentially limiting its benefits for patient outcomes. In view of this, a group of musculoskeletal US experts formed a working group to consider how this unmet need could be satisfied and to produce guidance (additional to EULAR imaging recommendations) to support clinicians in their daily clinical work. This paper describes this process and its outcome, namely six novel algorithms, which identify when US could be used. They are designed to aid diagnosis, inform assessment of treatment response/disease monitoring and to evaluate stable disease state or remission in patients with suspected or established RA, by providing a pragmatic template for using US at certain time points of the RA management. A research agenda has also been defined for answering unmet clinical needs. D A ARD-2016-209646 revised clean version 3Recently, the European League Against Rheumatism (EULAR) has produced recommendations for using imaging in rheumatoid arthritis (RA) management to aid diagnosis, assessment of prognosis, assessment of treatment response/disease activity and to support remission surveillance. 1 How these recommendations should be applied, however, is open to interpretation.Among the different imaging techniques, ultrasound (US) has shown to be of particular help in the diagnostic work-up of RA, in guiding treatment decisions and in monitoring disease activity and remission. Despite the difference in the quality of the US machines 2-4 and the possible different level of experience of the operators, published data supports the value of using US in the management of patients with inflammatory arthritis. 1 5 This evidence has encouraged many rheumatologists to embrace US in their clinical practice. 6 The expansion of US in rheumatology has occurred alongside, and is complementary to, the acceptance of the treat-to-target model, in which disease activity and response to treatment must be closely monitored. 7 The prompt diagnosis of RA and early initiation of disease-modifying anti-rheumatic drugs (DMARDs) reduce inflammation, limit disease progression, control symptoms and minimise functional loss. [8][9][10] According to the American College of Rheumatology (ACR)/EULAR classification criteria, 11 a patient with synovitis can be classified as having RA if a certain number of joints with synovitis are detected or if bone erosions are present. However, clinical examination and conventional radiography (CR) are neither sensitive nor accurate enough to detect disease activity and structural damage in early disease. [12][13][14][15] In contrast, US is able to detect synovitis at presentation and differentiate between intra-joint synovial inflammation and other causes of symptoms/swelling, such as tenosynovitis, bursitis and other soft tissue lesions. [16][17][18][19][20] This is also reflect...

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“…GS and PD sum scores for joints (both range 0–228) and tendons (both range 0–90) were calculated. The Global OMERACT-European League Against Rheumatism Synovitis Score (GLOESS)35 was additionally used to score synovitis. The number of entheses with enthesitis defined as GS structural pathology (thickening, hypoechogenicity, fibrillar separation, calcifications, erosions or enthesophytes) and/or PD signal at the entheses were registered (scored absent/present, both range 0–29) 34 36.…”

Section: Methodsmentioning

confidence: 99%

Ultrasonographic evaluation in psoriatic arthritis is of major importance in evaluating disease activity

et al. 2016

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Value of ultrasonography as a marker of early response to abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: results from the APPRAISE study

Cited by 83 publications

References 30 publications

Exploring a new ultrasound score as a clinical predictive tool in patients with rheumatoid arthritis starting abatacept: results from the APPRAISE study

Exploring a new ultrasound score as a clinical predictive tool in patients with rheumatoid arthritis starting abatacept: results from the APPRAISE study

Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission

Ultrasonographic evaluation in psoriatic arthritis is of major importance in evaluating disease activity

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