In patients with rheumatoid arthritis (RA) who are being treated with biological disease-modifying antirheumatic drugs (bDMARDs), joints with synovial hypertrophy without Doppler activity improve during treatment, according to study results published in Arthritis Research & Therapy.
These results indicate that synovial hypertrophy without Doppler activity is not a sign of inactive disease.
The study included participants initiating or switching bDMARD treatment. The researchers performed ultrasound on 36 joints at baseline, 3 months, and 6 months. They graded synovial hypertrophy by grayscale ultrasound and Doppler activity from 0 to 3 at the joint level. They assessed changes in synovial hypertrophy in joints without Doppler activity during treatment and compared them with changes in synovial hypertrophy in joints with Doppler activity.
The study included 151 participants with a mean age of 51.4 years, disease duration of 9.9 years, and baseline Disease Activity Score 28-joint count C-reactive peptide (DAS28-CRP) of 4.14.
The researchers found that at baseline, 44.8% of all joints examined (n=5225) had synovial hypertrophy ≥1 and 1191 had synovial hypertrophy without Doppler activity.
The results indicated that improvement in synovial hypertrophy was similar in joints with and without Doppler activity.
After adjusting for the baseline score of synovial hypertrophy, the researchers found that joints with synovial hypertrophy without Doppler activity were more likely to have a decrease in score compared with joints with synovial hypertrophy with Doppler activity, independent of grade (3 months: P <.0001; 6 months: P =.0003).
“These findings indicate that joints with synovial hypertrophy without Doppler activity should be taken into account when assessing disease activity by ultrasound,” the researchers wrote.
Terslev, Østergaard M, Sexton J, Hammer HB. Is synovial hypertrophy without Doppler activity sensitive to change? Post-hoc analysis from a rheumatoid arthritis ultrasound study. Arthritis Res Ther. 2018;20:224.