Musculoskeletal Ultrasound May Detect Inflammation Levels, Predict Future Joint Erosion in RA

person getting ultrasound of hand
person getting ultrasound of hand
Investigators compared the effectiveness of musculoskeletal ultrasonography to routine care in patients with moderate to severe rheumatoid arthritis who require a treatment change because of lack of efficacy.

Musculoskeletal ultrasound (MSUS) assessments may be useful in detecting subclinical inflammation levels and predicting future joint erosion in patients with rheumatoid arthritis (RA), according to study results published in Rheumatology.

The ECHO study was a prospective, 2-cohort study of adult patients with moderate to severe RA who required a change in treatment because of lack of efficacy or physician recommendation. Investigators enrolled patients between December 2014 and April 2017 and assigned them to receive either MSUS-guided care or routine care for 1 year. They conducted study visits at baseline and at 3, 6, 9, and 12 months of follow-up. Outcome measures included achievement of low disease activity (LDA) or remission on the Clinical Disease Activity Index (CDAI); achievement of LDA or remission on the 28-joint Disease Activity Score for RA with Erythrocyte Sedimentation Rate (DAS28-ESR); achievement of MSUS erosion score ≥1; and patient-reported satisfaction and participation in disease management. Researchers calculated prevalence rates of LDA and remission for the MSUS and routine care groups.

A total of 383 patients with RA were enrolled: 171 in the MSUS group and 212 in the routine care group. Mean age was 58.7±11.7 years; mean disease duration was 7±10 years; and 71.5% were women. Baseline demographic and clinical parameters were comparable between treatment groups, although greater levels of structural joint damage and physical disability were observed in the MSUS group. At baseline, a greater percentage of patients in the MSUS group were treated with a biologic disease-modifying antirheumatic drug (DMARD; 50.3% vs 36.8%; P =.008), whereas patients in the routine care group were more likely to receive nonbiologic DMARDs (84.2% vs 91.5%; P =.027). During follow-up, patients in the MSUS experienced a greater number of RA treatment modifications than patients in the routine care group (incidence rate ratio, 1.4; 95% CI, 1.1-1.8). No statistically significant differences in clinical outcome rates were observed between groups, although patients receiving MSUS had numerically higher odds of remission.

Among patients in the MSUS group, 50% and 76.9% of patients who achieved CDAI and DAS28-ESR remission at 3 months, respectively, had an MSUS synovitis score ≥1. In addition, 37.5% and 50% had an MSUS erosion score ≥1, supporting the agreement between MSUS parameters and CDAI and DAS28-ESR disease activity. In logistic regression, greater baseline power Doppler synovitis score was associated with increased odds of DAS28-ESR remission at 9 and 12 months and increased odds of DAS28-ESR LDA at 9 months. Increased power Doppler synovitis and overall synovitis at baseline were also predictive of joint deterioration during follow-up.

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In a cohort of patients with moderate to severe RA, MSUS parameters, including power Doppler score, were predictive of future joint deterioration. MSUS parameters were also associated with clinical remission. According to these results, investigators endorsed the use of MSUS in routine management of RA.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Stein M, Vaillancourt J, Rampakakis E, Sampalis JS. Prospective observational study to evaluate the use of musculoskeletal ultrasonography in rheumatoid arthritis management: the ECHO study [published online February 3, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/keaa004