Power Doppler Ultrasound May Allow Monitoring of Therapy Response in RA

Patients given biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) showed improved grey scale and power Doppler ultrasound imaging scores 6 months after receiving treatment, and biologic-naive patients had better improvement than patients who had switched therapies, according to a study published in Arthritis Care Research.

Patients (n=50) with active rheumatoid arthritis (RA) who received biologic and targeted synthetic DMARDs had treatment response and disease progression assessed by power Doppler ultrasound on 22 bilateral hand joints. Grey scale and power Doppler images were scored from 0 to 3 and remission was defined as a score of 0 on both image sets.

In patients receiving biologic and targeted synthetic DMARDs, total grey scale and power Doppler scores significantly decreased from baseline at both 3 and 6 months (P <.001). In addition, scores differed between biologic-naïve and targeted patients and patients switching from another medication, with naive patient scores improving compared with the switcher patient group. Remission occurred in 8% of patients who had taken two or more biologic treatments in the past, 15% in switchers who had taken one biologic treatment in the past, and 34% in biologic-naive patients.  

The multivariate logistic regression analysis revealed that absence of any previous biologic DMARD therapy (odds ratio [OR] 0.27; 95%CI, 0.10-0.68; P =.0047), short disease duration (OR 0.99; 95% CI, 0.99-1.00; P =.031), and low total power Doppler scores at baseline (OR 0.85; 95% CI, 0.76-0.94; P =.0003) were independent predictors of power Doppler remission at 6 months.

The study investigators wrote, “The previous use of [biologic disease-modifying antirheumatic drugs] as well as the baseline [power Doppler] activity may independently affect the [power Doppler] response in the early phase of [biologic DMARDs] therapy”. They added, “It is important to note that high [power Doppler] scores in [biologic DMARDs] switchers can signal the risk of a poor outcome with joint destruction.”

Reference

Nishino A, Kawashiri SY, Koga T, et al; Ultrasonographic efficacy of biologic and targeted synthetic DMARDs therapy in RA from multicenter RA ultrasound prospective cohort in Japan [published online February 26th, 2018]. Arthritis Care Res. doi:10.1002/acr.23551