RESEARCH - Power doppler ultrasonographic monitoring of response to anti-TNF therapy in patients with RA

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Arthritis Rheum. 2008 Jul 30;58(8):2248-2256.

Power doppler ultrasonographic monitoring of response to anti-tumor

necrosis factor therapy in patients with rheumatoid arthritis.

Naredo E, Möller I, Cruz A, Carmona L, Garrido J.

Hospital Severo Ochoa, Madrid, Spain.

OBJECTIVE: To evaluate the validity, responsiveness, and predictive

value of power Doppler ultrasonography (PDUS) monitoring of response

to tumor necrosis factor (TNF) blocking agents in rheumatoid arthritis

(RA). METHODS: Three hundred sixty-seven RA patients were

prospectively recruited at 25 Spanish centers; complete clinical,

laboratory, and PDUS data were obtained on 278 patients. The patients

underwent clinical, laboratory, and PDUS assessment at baseline and

after 1, 3, 6, and 12 months of anti-TNF treatment, and radiographic

assessment of the hands and feet at baseline and 12 months. The

Disease Activity Score in 28 joints (DAS28) was recorded at each

visit. PDUS examination included 86 intraarticular and periarticular

sites in 28 joints. US synovial fluid (SF), synovial hypertrophy (SH),

and PD signal were scored in all synovial sites. US count and index

for SF, SH, and PD signal were obtained. Sensitivity to change of the

PDUS variables was assessed by estimating the smallest detectable

difference (SDD) from the intraobserver variability. RESULTS: A

significant parallel improvement in DAS28 and PDUS parameters was

found at followup assessment (P < 0.0005 for within-subject

between-visit changes). The SDD for PDUS parameters was lower than the

mean changes throughout followup. Time-integrated values of US joint

count for PD signal and rheumatoid factor (RF) showed predictive value

in relation to progression of radiographic erosion (R = 0.64), and

time-integrated values of US joint count for PD signal, RF, and

erythrocyte sedimentation rate were predictors of progression of the

total radiographic score (R = 0.59).

CONCLUSION: These findings indicate that PDUS is a valid method for

monitoring response to anti-TNF therapy in RA; results obtained by

PDUS are reproducible and sensitive to change. PDUS findings may have

predictive value in relation to radiologic outcome.

PMID: 18668537

http://www.ncbi.nlm.nih.gov/pubmed/18668537

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