Abstract
Purpose: Comprehensive evaluation, including multiple recesses of all accessible peripheral joints, may be overly time-consuming in daily practice and in conducting clinical trials. This study aimed to investigate serial changes in synovitis activity at different joint level by ultrasonography (US) assessment of patients with rheumatoid arthritis (RA) on biological therapy and to determine simplified method of monitoring these patients and to search the lesser time consuming and can be used in clinical practice method. Methods: Patients with RA who received biological therapy were enrolled. All underwent power Doppler US assessment of 24 synovial sites A total of 396 joints and 792 synovial sites underwent power Doppler US assessment for five times (at baseline and at 1, 3, 6 and 12 months after biological therapy). A general lineal model was used to compare differences among the 12 sites. Findings: Thirty-three patients, 1980 joints, and 3960 synovial sites were evaluated. There were no significant differences in grayscale (p=0.335) and PD ultrasound (p=0.623) changes in the elbow, wrist, MCP, PIP, knee, and ankle joints. Implications: After 12 months, there are no differences among the 12 joints surveyed. It is not recommended to conduct full work-ups on more than one joint in clinical practice. Instead, a simplified joint evaluation is all that is required to avoid unnecessary time consumption.
Highlights
The assessment of joint inflammation is essential for diagnosing and monitoring response to therapies in patients affected by inflammatory arthropathies like rheumatoid arthritis (RA)
The use of musculoskeletal ultrasonography (US) with the power Doppler (PD) method has increased in the past decade
A comprehensive evaluation of multiple recesses of all accessible peripheral joints may be overly time-consuming in clinical practice and in clinical trials
Summary
The assessment of joint inflammation is essential for diagnosing and monitoring response to therapies in patients affected by inflammatory arthropathies like rheumatoid arthritis (RA). US is known to detect B-mode synovitis and synovial Doppler activity in RA patients treated with either synthetic or biologic disease-modifying anti-rheumatic drugs [1,2,3,4,5]. A comprehensive evaluation of multiple recesses of all accessible peripheral joints may be overly time-consuming in clinical practice and in clinical trials. The present study aimed to investigate serial changes in synovitis activity at different joint levels using US assessment on RA patients receiving biological therapy and determine possible simplified methods of monitoring these patients and to search the lesser time consuming and can be used in clinical practice method
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