Prediction of erosion progression using ultrasound in established rheumatoid arthritis: a 2-year follow-up study

  • Reynolds P
  • Heron C
  • Pilcher J
 et al. 
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OBJECTIVES: This study aimed to determine whether a range of single-time-point ultrasound (US) measures of synovial disease and serologic characteristics were able to predict progression of US-defined erosive disease in patients with established rheumatoid arthritis (RA). MATERIALS AND METHODS: Forty patients were studied prospectively. At baseline, subjective US measures of bone damage and synovial disease, including grayscale and power Doppler (PD) scores pre- and post-Sonovue contrast, were obtained from one proximal inter-phalangeal or metacarpo-phalangeal joint per patient. After a minimum of 2 years, the same joints were scanned to obtain a new US erosion score. RESULTS: Follow-up US erosion scores were obtained in 25 joints. Progressive US determined that bone damage occurred in 12/25 joints, including four of eight treated with anti-tumor necrosis factor therapy. Baseline erosion scores were significantly higher in joints that did not show progressive bone damage in the entire cohort (p = 0.05, n = 25) and a subgroup treated with disease-modifying anti-rheumatic drugs (p = 0.015, n = 17). There were no other significant differences in baseline US or serologic scores between joints that developed progressive damage and those that did not. CONCLUSIONS: The majority of single-time-point US measures of synovial disease were not able to identify metacarpo-phalangeal or inter-phalangeal joint destined to develop progressive US-determined bone damage in patients with established RA. This may reflect the use of single-time-point measures, insensitivity of the US erosion score, and the long duration of RA disease in this study.

Author-supplied keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid/pathology/*ultrasonography
  • Contrast Media
  • Disease Progression
  • Female
  • Finger Joint/pathology/*ultrasonography
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Phospholipids/diagnostic use
  • Predictive Value of Tests
  • Prospective Studies
  • Sulfur Hexafluoride/diagnostic use
  • Ultrasonography, Doppler/*methods

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  • P P Reynolds

  • C Heron

  • J Pilcher

  • P D Kiely

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