Artikel
Power doppler ultrasound in predicting the radiographic damage in patients with rheumatoid arthritis
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Autoren
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Olga Alekseeva
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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Aleksandr Smirnov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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Aleksandr Volkov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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Svetlana Glukhova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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Eugene Nasonov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| Veröffentlicht: | 8. Oktober 2019 |
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Gliederung
Text
Background: Ultrasound (US) changes in early RA are considered as one of the ways of predicting disease outcomes.
Objective: To detect power doppler (PD) contribution in evaluation of radiographic RA progression in long term.
Methods: 85 RA pts, mean age 53,0 [44,0; 61,0] yrs, mean disease duration 8 [4; 24] months were treated by Treat-To-Target concept. After first year of therapy management was following real clinical practice rules until the termination of the study (4 years FUP). The wrist, MCP2 and MCP3, PIP2, PIP3, MTP2 and MTP5 joints of the clinically dominant side were examined by US (GS and PD). Clinical, laboratory parameters and US examination was performed at baseline, at Mo 3, 6, 9 and 12. The X-ray was conducted before treatment and in the end of the study. Structural damage progression was evaluated by change in the Sharp van der Heijde score (ΔSHS) between baseline and 4 year.
We categorized pts into 5 groups according to the occurrence of positive PD: 1) without PD throughout the observational period [the negative (N)], 2) positive PD limited to the period from the baseline to Mo 3 [the therapeutic response (R)], 3) positive PD limited to the period from the baseline to Mo 6-9 [the therapeutic late-response (LR)], 4) intermittent occurrence of PD in the observational period [the intermittently positive (IP)] and 5) with persistent positive PD throughout the observational period [the persistently positive (PP)].
Results: 80% of pts had PD synovitis at baseline. PD-synovitis dropped from 2 [1,0; 6,0] to 0 [0,0; 2,0] scores at Mo 12. RA progression by 4 years FUP was identified in 13% of pts. The X-ray erosion score at 4 years FUP in these groups – N, R, LR, IP and PP - were dependent by PD from baseline to Mo 12 (mean level 1 [0; 2]; 2 [0; 4], 3 [0; 5], 1 [0; 2] and 4,5 [1; 10] respectively), but statistically significant differences were found between N and PP groups.
Cox multivariate analysis identified that PD-synovitis at baseline increased the probability of erosions (HR 3,68 95% CI 1,03 – 13,15, р = 0,045).
Conclusion: Thus, PD-synovitis has a prognostic value for increasing destructive radiographic changes.
