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.


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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.

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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.

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Reference

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.