Do we Really Need A Comprehensive Us Assessment of Joints in Rheumatoid Arthritis on Biological Therapy?

Abstract

The assessment of joint inflammation is essential in diagnosis and in monitoring response to therapies in patients affected by inflammatory arthropathies, such as RA. For this purpose, use of musculoskeletal US, with application of the Power Doppler (PD) method, has been increasing over the past decade. Musculoskeletal US had been used in the diagnosis and monitoring of RA [1-3]. Many scoring methods have strived to reduce joint counts at B-mode and Doppler synovitis as surrogates for comprehensive US assessment for monitoring [4-7] or diagnosing RA [8]. It has been demonstrated that US assessment can be useful in the management of RA and in monitoring the course of the disease [9]. The application of US is helpful in such evaluations and is a complementary tool to classic methods used to detect RA, such as clinical evaluation and radiography, particularly when MCP, PIP and MTP joints are considered [10-12] .Naredo et al developed a predictive value of Doppler ultrasound-detected synovitis in relation to failed tapering of biologic therapy in patients with rheumatoid arthritis [13]. Evidence has confirmed that grey-scale and PD evaluation demonstrated the correlation between disease activity and degree of inflammation of synovial tissue [14,15]. US can be used in the evaluation of the response to biological drugs. Naredo et al. [16] found a significant improvement in US parameters in RA patients undergoing therapy with a TNF blocking agent. Thus, the US evaluation could be a valid method for monitoring response to biological therapy in RA patients. However, a comprehensive evaluation including multiple recesses of all accessible peripheral joints may be overly time consuming in daily practice and when conducting clinical trials. Which joints and synovial recesses are appropriate for studying and monitoring RA patients remains unknown.