Study: Systemic ultrasound in the management of early rheumatoid arthritis is not justified

LONDON — The systemic use of ultrasound in the follow-up of patients with early rheumatoid arthritis is not justified, based on results of the ARCTIC trial, which were presented here at the EULAR Annual Congress.

“Subclinical inflammation can be treated, and strategies targeting imaging remission are feasible,” Espen A. Haavardsholm, MD, PhD, said. “However, imaging remission does not affect the treatment target and clinical remission and, as such, it is not cost-effective. Adding ultrasound information into strategic treatment and targeting the therapy toward imaging remission did not lead to improved patient outcomes.”

In the open-label, phase 4, multicenter, randomized, controlled trial, Haavardsholm and colleagues studied 238 newly diagnosed disease-modifying antirheumatic drug (DMARD)-naïve patients with rheumatoid arthritis (RA). Patients were randomized 1:1 to either an ultrasound tight control strategy group, which targeted clinical and imaging remission, or to the conventional tight control strategy group, which was based on clinical and laboratory assessments alone aiming for clinical remission. Inclusion criteria were fulfillment of the 2010 ACR/EULAR criteria, symptom duration of less than 2 years and DMARD naivety.

Patients in both groups had the same DMARD escalation strategy. The strategy started with methotrexate, then moved to a triple therapy of methotrexate, hydroxychloroquine and sulfasalazine, and then biologic DMARDs if the target was not reached. Haavardsholm said the primary endpoint of the study was the proportion of patients who had a combination of clinical remission with no swollen joints and no progression of radiographic joint damage seen between 16 months to 24 months.

Treatment target was clinical remission combined with imaging remission defined as disease activity score remission. Overall, 26 patients in the ultrasound tight control strategy group and 21 patients in the conventional tight control strategy group reached the primary endpoint. Researchers found no significant differences between the groups for the primary outcome and secondary endpoints.

Imaging remission, which was a defined treatment target in the ultrasound group, was reached by 75% of patients, he said. In addition, in the conventional group in which ultrasound was not allowed and was blinded, imaging remission was reached by more than 60% of patients. There were no differences in safety outcomes between the groups, Haavardsholm said. – by Kristine Houck, MA, ELS

Reference:

Haavardsholm EA, et al. Abstract #OP0177. Presented at: EULAR Annual Congress; June 8-11, 2016; London.

Disclosure: Haavardsholm reports he receives grant and research support from Pfizer, MSD, UCB Pharma, AbbVie and Roche.