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Ultrasound determined synovial thickness, PD signal in single joints of RA patients
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Ultrasound presence established synovial thickness and power-Doppler signal at baseline at the single-joint level in patients with rheumatoid arthritis and, together with extended power-Doppler signal, had predictive value for future joint erosion, according to study results.
Researchers in Italy studied 240 metacarpophalangeal (MCP) joints of 24 patients with rheumatoid arthritis (RA), which were evaluated clinically and by ultrasound (US) at baseline, 6 months and 1 year. Presence of synovial hypertrophy and power-Doppler (PD) vascularization, both graded on a semiquantitative (0-3) scale, and bone erosion amounts and dimensions were collected. At baseline and 1 year, X-rays were taken and lesions were graded using the Sharp/van der Heijde (S/vdH) method. Logistic regression analysis entered potential prognostic determinants for joint damage obtained at initial examination and during follow-up.
On X-ray, 88% of newly eroded joints had persistent PD vascularity, and 82% had persistent synovial thickening compared with noneroded joints (P=.001 and P=.02, respectively). Synovial PD scores of 2 or greater on at least two US evaluations (new X-ray erosions, OR=8.51; 95% CI, 1.84-39.48; increased S/vdH local joint score, OR=8.30; 95% CI, 1.97-38.9) were the most important factor associated with the development of radiological joint damage, according to multivariate analysis. Joint damage development also was significantly associated with baseline synovial scores of 2 or higher and presence of X-ray erosions.
“Two predictive models for X-ray erosions and total single-joint level S/vdH damage score were constructed consisting of two baseline plus one longitudinal variable with an [area under the receiver operating characteristic curve] of 0.916 (95% CI, 0.867-0.965) and 0.886 (95% CI, 0.814-0.957),” the researchers said.
“US determined synovial hypertrophy and PD score at baseline, and the persistence of a positive PD score over time in MCP joints may predict the rate of progression of joint damage,” the researchers concluded. “We believe that the time has come to routinely use US as a basic tool to evaluate the disease activity and the response to treatment in patients with RA.”
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