Ultrasound Is a Better Target Than Clinical Disease Activity Scores in Rheumatoid Arthritis

Abstract

The assessment of joint inflammation is essential for diagnosing and monitoring response to therapies in patients affected by inflammatory arthropathies like rheumatoid arthritis (RA). For this, the use of musculoskeletal ultrasonography (US) with the power Doppler (PD) method has increased in the past decade. Also, 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. The US-detected synovitis has a predictive value in relation to radiographic damage progression and disease flare-up or relapse. Assessment by US ranges from wrist and hand joints to a comprehensive examination of 44 joints. Ultrasonographic (US) assessment has been shown to be useful in the management of RA and for monitoring the disease course. The application of US is helpful in such evaluations and is a complementary tool for classic methods used to detect RA, such as clinical evaluation and radiography, particularly when the MCP, PIP, and MTP joints are considered. Evidence has confirmed that GS and PD evaluation demonstrates a correlation between disease activity and degree of inflammation of synovial tissue. Moreover, US can be used for evaluating response to biological drugs. Naredo et al. have found a significant improvement in US parameters in RA patients undergoing therapy with a TNF blocking agent. Thus, US evaluation may be a valid method for monitoring response to biological therapy in RA patients. Finally, sonographic synovitis predicts erosion better than swollen joint count, C-reactive protein and erythrocyte sedimentation rate, US should be considered a promising treatment target in RA patients.