Radiographic prognosis of finger joint damage predicted by early alteration in synovial vascularity in patients with rheumatoid arthritis: Potential utility of power doppler sonography in clinical practice

Abstract

Objective. To investigate the relationship between synovial vascularity and progression of structural bone damage in each finger joint in patients with rheumatoid arthritis (RA) and to demonstrate synovial vascularity as a potential therapeutic marker. Methods. We studied 250 metacarpophalangeal (MCP) and 250 proximal interphalangeal (PIP) joints of 25 patients with active RA who were administered adalimumab or tocilizumab. Patients were examined with clinical and laboratory assessments. Power Doppler sonography was performed at baseline and at the fourth and eighth weeks. Synovial vascularity was evaluated according to quantitative measurement. Hand and foot radiography was performed at baseline and the twentieth week. Results. Clinical indices such as the 28-joint Disease Activity Score, the Clinical Disease Activity Index, and the Simplified Disease Activity Index were significantly decreased by biologic agents. The MCP and PIP joints with no response in synovial vascularity between baseline and the eighth week (vascularity improvement of <70% at the eighth week) showed a higher risk of radiographic progression compared with responsive joints (vascularity improvement of >70% at the eighth week; relative risk 2.33-9). Radiographic progression at the twentieth week was significantly lower in responsive joints than in nonresponsive joints. Conclusion. The improvement of synovial vascularity following treatment with biologic agents led to suppression of radiographic progression of RA in each finger joint. The alteration in synovial vascularity numerically reflected therapeutic efficacy. Using vascularity as a marker to determine the most suitable therapeutic approach would be beneficial for patients with active RA.

Advances in sonographic scoring of rheumatoid arthritis

“…Synovitis plays an important role in the joint-destroying process. It has been shown that no bone destruction occurs in the absence of synovitis 9 10. Grey-scale US (GSUS) allows a differentiation between exudative and proliferative synovial changes as it provides a good soft-tissue contrast.…”

Using Dermal Temperature to Identify Rheumatoid Arthritis Patients With Radiologic Progressive Disease in Less Than One Minute

“…This exploratory study was sized by expert opinion and based on the sample sizes used in numerous radiographic RA studies 6, 12, 13, 14. The baseline temperature discrimination threshold (0.1°F) defines 2 sets of patients, the hot‐joint (≥0.1°F) and cool‐joint (<0.1°F) predictor sets.…”

“…However, despite having lower sensitivity and specificity for predicting serious disease, there is a trend toward utilizing laboratory tests and scales to interpret inflammation (e.g., Westergren erythrocyte sedimentation rate [ESR] and C‐reactive protein [CRP] level) or pain (visual analog scale), as well as numerous functional assessment tools (i.e., the Health Assessment Questionnaire [HAQ] and Routine Assessment of Patient Index Data [RAPID3]) 4. Newer approaches like the multibiomarker disease activity test and ultrasound or MRI measurement of joints are quite costly 5, 6, 7. Thus, there is a need for a simple, cost‐effective tool for determining which patients will develop progressive, destructive RA.…”

Use of ultrasound in treatment decisions for patients with rheumatoid arthritis: an observational study in Italy

“…Findings from a number of studies investigating the use of ultrasound in daily rheumatologic practice have suggested that ultrasound can be used to monitor therapy in real-life clinical practice settings [2,3,[7][8][9][10][11].…”