Musculoskeletal ultrasound as a biomarker of remission – results from a one-year prospective study in patients with rheumatoid arthritis

Sapundzhieva, Tanya; Karalilova, Rositsa; Batalov, Anastas

doi:10.11152/mu-1609

Cited by 11 publications

(7 citation statements)

References 48 publications

(64 reference statements)

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“…They stated that once clinical remission is attained, subclinical synovitis becomes independent of the type of treatment. This finding was confirmed later by Sapundzhieva et al, 2018 (38) in their prospective study to test the US findings as a biomarker for remission. They reached a conclusion that there was GS evidence of synovitis regardless the type of treatment-whether bDMARDs or cDMARDs.…”

Section: Discussionsupporting

confidence: 54%

“…Disease remission, being the ultimate goal of RA treatment strategies, is currently defined using indexbased criteria that could not define the absence of synovitis, and consequently absence of disease (28) . Therefore, the persistence of subclinical joint inflammation can only be detected through sensitive imaging techniques such as MSUS (29) .…”

Section: Discussionmentioning

confidence: 99%

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High Resolution Ultrasonography and Power Doppler in Evaluation of Disease Activity of Rheumatoid Arthritis Patients in Clinical Remission or Low Disease Activity

2020

Journal of the Medical Research Institute

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Background: Chronic Achieving remission or at least low disease activity is the ultimate goal of rheumatoid arthritis patients' treatment nowadays. Defining remission using indices based on clinical and laboratory biomarkers was proved to be lacking sensitivity to detect low levels of inflammation. Musculoskeletal ultrasound (MSUS) has been able to detect and quantify subclinical synovitis, with more specificity and reliability. Aim: To detect the persistence of GS and PD signals in RA patients in clinical remission or LDA as assessed by DAS28-ESR. Patients and methods:: Fifty consecutive RA patients in clinical remission or LDA were included. Patients were subjected to routine laboratory work up, RF and Anti-CCP measurement. Disease activity was determined by DAS28-ESR. US7 score was used to assess synovitis and vascularization with GSUS and PDUS respectively. Results: All patients in LDA showed activity by GSUS or PDSUS. 13 (38.2%) patients of those in clinical remission showed subclinical GSUS or PDUS activity, while 21 (61.2%) were in clinical and US remission. Female patients showed more tenosynovitis PDUS signals than males (P=0.039). There was no statistically significant difference between patients on cDMARDs and bDMARDs regarding the US7 score. Anti-CCP showed statistically significant difference between patients in true remission and patients with subclinical US activity (P=0.006). A strong correlation was found between Anti-CCP and S-PDUS in patients with subclinical US activity (P=0.001), and T-GSUS in same group of patients (P=0.023). Conclusion: Subclinical synovitis is a frequent finding in the joints of RA patients in clinical remission or LDA and occurs independently from the treatment. This may reclassify patients with either LDA or clinical remission. Female patients show more frequent subclinical PDUS activity. Anti-CCP levels of RA patients in clinical remission with subclinical synovitis correlated with PD signals and tenosynovitis GS.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

High Resolution Ultrasonography and Power Doppler in Evaluation of Disease Activity of Rheumatoid Arthritis Patients in Clinical Remission or Low Disease Activity

2020

Journal of the Medical Research Institute

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“…Convincing literature evidence shows that there is a quantitative positive relationship between remission and residual ultrasound activity. On one hand, the lack of ultrasound activity predicts achievement and persistence of remission (33,34). On the other hand, there is a very high degree of confidence that residual synovial activity is a significant predictor for loss of remission (relapse, flare) and radiographic progression since controlled studies (35)(36)(37), meta-analyses (38,39), magnetic resonance imaging (MRI) studies (40)(41)(42)(43)(44)(45)(46), biological markers (14) and histology (47,48) have confirmed the cited ultrasound observations.…”

Section: Introductionmentioning

confidence: 73%

Clinical and ultrasound ankle involvement in rheumatoid arthritis in remission

Enache¹,

Popescu²,

Codreanu³

et al. 2019

Ro J Rheumatol.

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Objective. We aimed to evaluate the prevalence and differences of clinical and ultrasound involvement of ankles in rheumatoid arthritis (RA) patients in remission. Methods. RA patients were recruited in 2018 in the random order of presentation from the outpatient clinic. In the day of enrolment, all patients underwent clinical examination (by a senior rheumatologist, blind to other evaluations), inflammatory markers (e.g. C-reactive protein-CRP) and ankle ultrasound (performed and interpreted by a single rheumatologist with more than 7 years of experience). Results. The sample included 59 patients in DAS28CRP remission, 27 in SDAI remission and 20 in Boolean remission. Among these 3 categories of remission, overall clinical ankle involvement presented similar prevalence (revolving around 30%). On average, 77% of patients presented overall ultrasound ankle involvement among the 3 categories of remission, with similar frequencies of ankle joint synovial hypertrophy (SH; 33%), power Doppler (PD) positive joint SH (15%), ankle joint effusion (60%), ankle tenosynovitis (27%) and PD positive ankle tenosynovitis (15%). In the subgroup of RA patients in DAS28CRP remission, compared to patients without clinical or ultrasound ankle involvement, those with at least one involved ankle had a significantly higher median CRP (0.34 mg/dl versus 0.19 mg/dl, p = 0.042). Conclusion. Among RA patients in remission, regardless of its definition, clinical and ultrasound involvement of ankles is frequent. Clinical and ultrasound screening of ankles in RA patients in remission seems an appropriate strategy.

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“…Its use is now mostly restricted to the quantification of inflammatory changes in the context of clinical trials [ 4 ]. MSUS is more readily available, can be used by clinicians during office hours, and provides higher spatial resolution than MRI [ 5 – 7 ]. For this reason, it has become the method of first choice for diagnosing early arthritis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study

et al. 2022

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Objectives To investigate the performance of dual-energy CT (DECT)-generated iodine maps (iMap) and CT subtraction (CT-S) in the detection of synovitis, tenosynovitis, and peritendonitis/paratenonitis compared to magnetic resonance imaging (MRI) using musculoskeletal ultrasound (MSUS) as standard of reference. Methods This IRB-approved prospective study consecutively investigated patients with undifferentiated arthritis. All patients underwent MSUS, MRI and contrast-enhanced DECT of the hand; from the latter conventional CT-S, image-based iMap (iMap-I) and raw data-based iMap (iMap-RD) were reconstructed. CT and MRI datasets were scored for synovitis and tenosynovitis/paratenonitis applying the modified Rheumatoid Arthritis MRI Score (RAMRIS). Sensitivity, specificity, and diagnostic accuracy were calculated. Non-inferiority was tested using the one-tailed McNemar test. Correlation of sum scores was assessed using Pearson’s test. Interreader reliability was assessed using Cohen’s kappa. Results Overall, 33 patients were included. MSUS was positive for synovitis and tenosynovitis/paratenonitis in 28 patients with a sum score of 6.91. Excellent correlation with MSUS was shown for CT-S (sum score 6.38; r = 0.91), iMap-RD (sum score 9.74; r = 0.82), MRI (sum score 12.70; r = 0.85), and iMap-I (sum score 6.94; r = 0.50). CT-S had the highest diagnostic accuracy of 83%, followed by iMap-I (78%), MRI (75%), and iMap-RD (74%). All modalities showed non-inferiority. Reader agreement was good for CT-S and MRI (κ = 0.62; 0.64) and fair for iMap-RD and iMap-I (κ = 0.31; 0.37). Conclusion CT-S and iMap allow highly standardized arthritis imaging and are suitable for clinical practice. MSUS still has the highest availability for arthritis imaging and served as gold standard for this study. Key Points • CT subtraction, iodine map with dual-energy CT, and MRI showed non-inferiority to musculoskeletal ultrasound. • MRI was the most sensitive but least specific imaging technique compared with CT subtraction and dual-energy CT. • CT subtraction showed the best correlation with musculoskeletal ultrasound.

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Musculoskeletal ultrasound as a biomarker of remission – results from a one-year prospective study in patients with rheumatoid arthritis

Cited by 11 publications

References 48 publications

High Resolution Ultrasonography and Power Doppler in Evaluation of Disease Activity of Rheumatoid Arthritis Patients in Clinical Remission or Low Disease Activity

High Resolution Ultrasonography and Power Doppler in Evaluation of Disease Activity of Rheumatoid Arthritis Patients in Clinical Remission or Low Disease Activity

Clinical and ultrasound ankle involvement in rheumatoid arthritis in remission

Contrast-enhanced CT techniques and MRI perform equally well in arthritis imaging of the hand: a prospective diagnostic accuracy study

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