Baseline Joint Ultrasonography: Does It Improve Prediction of RA Treatment Failure?

Adding baseline ultrasonography of the hands, wrists, and feet does not appear to improve prediction of failure to achieve rheumatoid arthritis (RA) disease remission at 12 months for patients with early RA, according to results published in Arthritis Research & Therapy.

In this study, the researchers followed a multicenter cohort patients with newly diagnosed RA for 1 year (n=194). At baseline, physicians performed ultrasonography of the hands, wrists, and feet in addition to recording clinical, laboratory, and radiographic parameters.

The primary outcome was the prediction of the absence of Disease Activity Score assessing 28 joints (DAS28) remission (<2.6) 12 months after diagnosis and start of therapy.

Of the 194 total patients, the researchers used 174 in their analysis, with complete data for 159 patients. Of the 159 patients, 61 (38%) failed to achieve DAS28 remission at 12 months. These patients tended to have a higher DAS28 score and higher erythrocyte sedimentation rate at baseline. However, neither the ultrasonography joint count nor ultrasonography erosion score were associated with treatment failure at 12 months.

Using a multivariate model with baseline DAS28 (odds ratio [OR], 1.6; 95% CI, 1.2-2.2), the presence of rheumatoid factor (OR, 2.3; 95% CI, 1.1-5.1), and type of monitoring strategy (OR, 0.20; 95% CI, 0.05-0.85), the addition of baseline ultrasonography results for joints (OR, 0.96; 95% CI, 0.89-1.04) did not significantly improve the prediction of failure to achieve DAS28 remission (likelihood ratio test, 1.04; P =.31).

“Although our study has shown that the added predictive value of routinely performed [ultrasound] at baseline in early RA patients is absent if treated to target, [ultrasound] still has a place in personalized medicine for specific indications. For example, in patients for whom the widely used DAS28 is less valid,” the authors noted.

Reference

Ten Cate DF, Jacobs JWG, Swen WAA, et al. Can baseline ultrasound results help to predict failure to achieve DAS28 remission after 1 year of tight control treatment in early RA patients? Arthritis Res Ther. 2018;20:15.