Delay in imaging versus clinical response: A rationale for prolonged treatment with anti–tumor necrosis factor medication in early rheumatoid arthritis

Wakefield, Richard J.; Freeston, Jane; Hensor, Elizabeth M A; Bryer, Domini; Quinn, Mark; Emery, Paul

doi:10.1002/art.23097

Cited by 65 publications

(43 citation statements)

References 8 publications

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“…Although this is to be expected, as lower cut-off points will include fewer swollen or tender joints and therefore lower assessments of disease activity, it also indicates that SDAI is able to capture some of the influence of residual disease activity, which can be present in subclinical synovitis in patients in clinical remission [11]. Further studies are required to assess whether these findings are also associated with clinically significant outcomes.…”

Section: Discussionmentioning

confidence: 98%

“…Both scores are useful in assessing moderate or high disease activity or therapeutic responses, and correlate with changes in sensible imaging techniques like US [12,27]. A number of studies have reported the superiority of US over clinical evaluation for detecting joint inflammation [11,[28][29][30][31][32]. Our results confirm previous reports showing that US-detected active synovitis, which is often subclinical, is present in patients in clinical remission, although these studies were carried out using small numbers of patients or joints [11,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have reported the superiority of US over clinical evaluation for detecting joint inflammation [11,[28][29][30][31][32]. Our results confirm previous reports showing that US-detected active synovitis, which is often subclinical, is present in patients in clinical remission, although these studies were carried out using small numbers of patients or joints [11,13,14]. The strength of our study is that a large number of joints was studied, providing a total body synovitis score that reflects the overall disease activity.…”

Section: Discussionmentioning

confidence: 99%

“…This is important because synovitis represents a potential surrogate of disease activity [9]. Currently, US with power Doppler (PD) is being considered as an extension of the clinical examination because it provides direct visualization and assessment of synovitis [10], is relatively inexpensive, is non-invasive, allows one to achieve good representation of the patient's activity by imaging multiple joints in one session [11] and is useful for monitoring the response to RA therapy [12].…”

Section: Introductionmentioning

confidence: 99%

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Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard

et al. 2010

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Objective. To investigate the accuracy of composite scores in classifying RA patients who are in remission using the absence of inflammatory activity detected by ultrasound (US) as a gold standard.Methods. Ninety-seven RA patients who were classified by their rheumatologists as being in remission were studied. Disease activity was assessed by the DAS-28 and simplified disease activity index (SDAI). US examination was performed in mode B and power Doppler (PD) in 42 joints.Results. Synovial hypertrophy (SH) and PD were present in 92 (94.8%) and 41 (42.3%) patients. If we consider 'remission' to be the absence of joints with PD signal, no differences were found by DAS-28 between patients in remission and those not in remission, although differences were present by SDAI. We then calculated the sensitivity (S), specificity (Sp) and positive likelihood ratio (LR) of different SDAI cut-off points to predict absence of PD signal. SDAI < 5 had an S of 65% (95% CI 52, 76), Sp of 55% (95% CI 39, 69) and LR of 1.45 (95% CI 0.98, 2.15), whereas SDAI < 3.3 had an S of 57% (95% CI 44, 69), Sp of 74% (95% CI 58, 85) and LR of 2.24 (95% CI 1.25, 4.01). Conclusions.Our results suggest that the SDAI classification of remission is closer to the concept of an absence of inflammatory activity, as defined by the absence of positive PD signal by US.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard

et al. 2010

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“…This means that imaging studies enable assessment of patients independent of clinical examinations. In this regard, many studies reported that synovitis detected on MRI or flow signal on PD-US progresses to bone destruction [28][29][30]. Taking these results into account, absence of synovitis or bone edema on MRI, or lack of flow signal on PD-US, could represent imaging criteria for remission and information that could help in clinical decision-making regarding discontinuation of biological treatment.…”

Section: Discussionmentioning

confidence: 95%

Comparison of low-field dedicated extremity magnetic resonance imaging with articular ultrasonography in patients with rheumatoid arthritis

Horikoshi¹,

Suzuki²,

Sugihara³

et al. 2010

Mod Rheumatol

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To compare magnetic resonance imaging (MRI) and ultrasonography (US) in the detection of joint inflammation of rheumatoid arthritis (RA), 6 patients with RA were examined by US and low-field 0.3-T nonenhanced dedicated extremity MRI (compacTscan). All patients were females, with mean age of 50.2 years, mean disease duration of 13.5 years, and mean disease activity score (DAS)28-CRP of 1.78. Each patient was treated with either infliximab, etanercept, adalimumab, or tocilizumab. Intercarpal joints, radioulnar joints, second through fifth proximal interphalangeal (PIP) joints, and first through fifth metacarpophalangeal (MCP) joints (a total of 132 joints, 22 joints in each patient) were assessed by MRI for presence of joint inflammation. A total of 156 joints (24 first interphalangeal and radiocarpal joints plus the above 132 joints), were assessed by grayscale US (GS-US) and power Doppler US (PD-US) for presence of joint inflammation by two trained ultrasonographers. We assessed correlations between joint inflammations on MRI and GS-US/PD-US, and also interobserver correlation between the two ultrasonographers by calculating intraclass correlation coefficients (ICC). Synovial hypertrophy and/or synovial fluid was detected in 74/156 joints on GS-US, and synovitis was detected in 10/156 joints on PD-US and in 38/132 joints on MRI. Using PD-US as a reference, sensitivity of MRI in detection of synovitis was 80%. Using MRI as a reference, sensitivity of PD-US was 21%. Specificity of PD-US was higher than that of MRI. Overall agreement between GS-US and MRI and between PD-US and MRI was 0.56 and 0.76, respectively, suggesting that results of PD-US are close to those of MRI. ICC was 0.545 for GS-US and 0.807 for PD-US, suggesting specificity of PD-US in detecting joint inflammation. Our results show that findings of PD-US correlated with those of MRI. Low-field MRI and PD-US are useful tools for assessment of patients with RA.

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Ultrasound in American Rheumatology Practice: Report of the American College of Rheumatology Musculoskeletal Ultrasound Task Force

Ike

Arnold

et al. 2010

Arthritis Care & Research

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Delay in imaging versus clinical response: A rationale for prolonged treatment with anti–tumor necrosis factor medication in early rheumatoid arthritis

Cited by 65 publications

References 8 publications

Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard

Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard

Comparison of low-field dedicated extremity magnetic resonance imaging with articular ultrasonography in patients with rheumatoid arthritis

Ultrasound in American Rheumatology Practice: Report of the American College of Rheumatology Musculoskeletal Ultrasound Task Force

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