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Real benefits of ultrasound evaluation of hand and foot synovitis for better characterisation of the disease activity in rheumatoid arthritis

Ciurtin, C; Jones, A; Brown, G; Sin, F; Raine, C; Manson, J; Giles, I; (2019) Real benefits of ultrasound evaluation of hand and foot synovitis for better characterisation of the disease activity in rheumatoid arthritis. European Radiology 10.1007/s00330-019-06187-8. (In press). Green open access

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Abstract

OBJECTIVE: Optimal management of rheumatoid arthritis (RA) depends on accurate evaluation of disease activity. Foot synovitis is not included in the most used RA outcome measure (DAS-28 score). The aim of this study was to investigate how ultrasound (MSK-US) examination of hand and feet correlate with DAS-28 score. We also explored whether performing MSK-US assessments of hands alone compared to hands and feet underestimates the disease activity in RA. METHODS: This is a real-life cross-sectional study of 101 patients (51 with RA and 50 with other musculoskeletal conditions) with inflammatory small joint pain, who underwent MSK-US examination of hands and feet. RESULTS: SK-US detected hand synovitis was found in 18/51 (35.3 %) RA patients and 16/50 (32%) of those with other musculoskeletal conditions (P=0.96), while foot synovitis was detected in 18/51 (35.3%) and 12/50 (24%) patients, respectively (P=0.78). DAS-28 did not correlate with any of the US outcome measures in patients with RA. Six out of 13 (46.1%) RA patients in remission, 7/14 (50%) with low disease activity and 18/32 (56.2%) with moderate disease activity (according to DAS-28 definition) had active synovitis as assessed by the MSK-US examination of their hands and feet. MSK-US detected synovitis led to treatment escalation in 26/51 (51%) RA patients. CONCLUSION: This study emphasises that MSK-US examination of hands and feet has led to optimised management of the majority of RA patients, which would have not been possible otherwise, because of the lack of correlation between DAS-28 assessment and MSK-US outcomes.

Type: Article
Title: Real benefits of ultrasound evaluation of hand and foot synovitis for better characterisation of the disease activity in rheumatoid arthritis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s00330-019-06187-8
Publisher version: https://doi.org/10.1007/s00330-019-06187-8
Language: English
Additional information: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
Keywords: musculoskeletal ultrasound; rheumatoid arthritis; Power Doppler
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation
URI: https://discovery.ucl.ac.uk/id/eprint/10067954
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