Ultrasound-Verified Synovitis and Seropositivity Best Identify Early Rheumatoid Arthritis

Patients who require treatment at the earliest stages of rheumatoid arthritis (RA) can be identified using a combination of ultrasound and serologic findings, including the measurement of autoantibodies of rheumatoid factor or anti-cyclic citrullinated peptide antibodies, according to results of a retrospective study published in the International Journal of Rheumatic Diseases.

The investigators sought to identify objective and comprehensive diagnostic criteria for early-stage RA that are based on ultrasound and serologic findings. A retrospective study was conducted at 2 Japanese hospitals, Nagasaki University Hospital and Isahaya General Hospital in Nagasaki, Japan, among patients who were suspected of having RA. Between August 2014 and May 2016, a total of 216 consecutive patients were recruited from Nagasaki University Hospital and 223 consecutive patients were recruited from Isahaya General Hospital. All participants underwent ultrasound of both hands. In the ultrasound of bilateral hands taken from 22 sites, the findings obtained from grayscale and power Doppler evaluations were each graded on a semiquantitative scale from 0 to 3.

Additionally, the researchers examined the assessment of the novel Outcome Measures in Rheumatology (OMERACT)-European League Against Rheumatism (EULAR) combined power Doppler ultrasound score and the Global OMERACT-EULAR Synovitis score. Ultrasound findings, along with the combination of ultrasound and serologic findings, were used to assess the diagnostic performance of these modalities.

Overall, 32.4% of patients at Nagasaki University Hospital and 26.5% of those at Isahaya General Hospital were diagnosed with RA. The best-balanced diagnostic performance at each of the hospitals was attained using a combination, such as (1) the presence of power Doppler grade ≥2 articular synovitis or (2) the presence of power Doppler grade ≥1 articular synovitis and serologic positivity, as well as using (1) the presence of combined power Doppler grade 3 or (2) combined power Doppler grade ≥2 and serologic positivity.

The investigators concluded that the combination of a power Doppler evaluation or the combined power Doppler score with the measurement of autoantibodies of rheumatoid factor or anti-cyclic citrullinated peptide antibodies can accurately identify those individuals with early-stage RA. The use of combination criteria demonstrated good diagnostic performance at 2 different hospitals.

Reference

Kawashiri SY, Fujikawa K, Nishino A, et al. Combination of ultrasound power Doppler-verified synovitis and seropositivity accurately identifies patients with early-stage rheumatoid arthritis [published online March 18, 2019]. Int J Rheum Dis. doi:10.1111/1756-185X.13543