Is Ultrasonography Beneficial in Early RA?

Compared with a conventional treat-to-target strategy, an ultrasonography-guided treat-to-target strategy for early rheumatoid arthritis (RA) does not reduce inflammation assessed by magnetic resonance imaging (MRI) or cause less structural damage, according to findings of a new study.

To reach this conclusion, the researchers analyzed data on 230 patients with early RA who were naive to any treatment with a disease-modifying antirheumatic drug (DMARD). The researchers randomly assigned the patients to receive either an ultrasonography tight-control strategy that targeted a disease activity score (DAS) of less than 1.6, no swollen joints, and no power Doppler signal in any joint, or a conventional strategy that targeted a DAS of less than 1.6 and no swollen joints.

The same DMARD escalation strategy was used to treat all participants.

The participants underwent an MRI scan of the dominant hand at 6 time points over 2 years; MRI scans were scored according to the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system.

Overall, 218 participants had a baseline MRI scan and 1 or more follow-up MRI scan and were included in the analysis.

By assessing the mean MRI score change from baseline to each follow-up, the researchers determined that there was no statistically significant difference in improvement of MRI bone marrow edema, synovitis, and tenosynovitis between the ultrasonography and conventional arms at any time point.

The 2-year risk progression of erosions as assessed by MRI was similar between the ultrasonography arm (39%) and conventional arm (33%); the relative risk was 1.16 (95% CI, 0.81-1.66).

“The findings support that systematic use of ultrasound does not provide a benefit in the follow-up of patients with early RA,” the researchers concluded.

—Colleen Murphy

Reference:

Sundin U, Aga A-B, Skare Ø, et al; ARCTIC Study Group. Conventional versus ultrasound treat to target: no difference in magnetic resonance imaging inflammation or joint damage over 2 years in early rheumatoid arthritis [published January 30, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/kez674.