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Ultrasound to identify SLE patients with musculoskeletal symptoms who respond best to therapy: The USEFUL longitudinal multicentre study

Mahmoud, K; Zayat, AS; Yusof, MYM; Dutton, K; Teh, LS; Yee, C-S; D'Cruz, D; ... Vital, EM; + view all (2021) Ultrasound to identify SLE patients with musculoskeletal symptoms who respond best to therapy: The USEFUL longitudinal multicentre study. Rheumatology , 60 (11) pp. 5194-5204. 10.1093/rheumatology/keab288. Green open access

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Abstract

OBJECTIVE: To determine whether SLE patients with inflammatory joint symptoms and ultrasound-synovitis/tenosyovitis achieve better clinical responses to glucocorticoid compared with patients with normal scans. Secondary objectives included identification of clinical features predicting ultrasound-synovitis/tenosynovitis. METHODS: In a longitudinal muticentre study, SLE patients with physician-diagnosed inflammatory joint pain received intramuscular methylprednisolone 120 mg once. Clinical assessments, patient-reported outcomes, and bilateral hands/wrist ultrasound were collected at 0-, 2- and 6-weeks. The primary outcome (determined via internal pilot) was early morning stiffness visual analogue scale (EMS-VAS) at 2-weeks, adjusted for baseline, comparing patients with positive (Grey-scale ≥2 and/or Power-Doppler ≥1) and negative ultrasound. Post-hoc analyses excluded fibromyalgia. RESULTS: Of 133 patients, 78 had positive ultrasound. Only 53/78 (68%) of these had ≥1 swollen joint. Of 66/133 patients with ≥1 swollen joint, 20% had negative ultrasound. Positive ultrasound was associated with joint swelling, symmetrical small joint distribution and serology. The primary end point was not met: in the full analysis set (n = 133) there was no difference in baseline-adjusted EMS-VAS at week-2 (-7.7 mm 95% CI -19.0 mm, 3.5 mm, p= 0.178). After excluding 32 patients with fibromyalgia, response was significantly better in patients with positive ultrasound at baseline (baseline-adjusted EMS-VAS at 2-weeks -12.1 mm, 95% CI -22.2 mm, -0.1 mm, p= 0.049). This difference was greater when adjusted for treatment (-12.8 mm (95% CI -22mm, -3mm), p= 0.007). BILAG and SLEDAI responses were higher in ultrasound-positive patients. CONCLUSIONS: In SLE patients without fibromyalgia, those with positive ultrasound had better clinical response to therapy. Imaging-detected synovitis/tenosynovitis may be considered to decide on therapy and enrich clinical trials.

Type: Article
Title: Ultrasound to identify SLE patients with musculoskeletal symptoms who respond best to therapy: The USEFUL longitudinal multicentre study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/rheumatology/keab288
Publisher version: https://doi.org/10.1093/rheumatology/keab288
Language: English
Additional information: Copyright © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com.
Keywords: Biomarkers, Clinical Trials and methods, Outcome Measures, Systemic Lupus Erythematosus, Ultrasound
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/10128992
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