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Chen CC, Chen DY. The Clinical Utility of Musculoskeletal Ultrasound for Disease Activity Evaluation and Therapeutic Response Prediction in Rheumatoid Arthritis Patients: A Narrative Review. J Med Ultrasound 2023; 31:275-281. [PMID: 38264607 PMCID: PMC10802883 DOI: 10.4103/jmu.jmu_126_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2024] Open
Abstract
Rheumatoid arthritis (RA) is characterized by persistent synovitis and joint/bone destruction. There is an unmet need to predict the therapeutic response to disease-modifying anti-rheumatic drugs (DMARDs) and achieve a treat-to-target goal. Musculoskeletal ultrasound (MSUS) is widely used to identify structural change and assess therapeutic response in RA. This review aims to summarize the available evidence regarding the clinical application of MSUS in evaluating disease activity and predicting therapeutic responses to DMARDs. We searched the MEDLINE database using the PubMed interface and reviewed English-language literature from 2000 to 2022. This review focuses on the updated role of MSUS in assessing disease activity and predicting therapeutic responses to DMARDs in RA patients. MSUS is now widely applied to identify articular structural change and assess the disease activity of RA. Combined use of gray scale and power Doppler MSUS is also superior to clinical assessment and laboratory examination in evaluating disease activity of RA. With portable use, good viability, and high sensitivity to articular inflammation, MSUS would be useful in assessing therapeutic response to biologic/targeted synthetic DMARDs (b/tsDMARDs) in RA patients. Given MSUS could also detect subclinical inflammation in a substantial proportion of RA patients with clinical remission, it is recommended to assess b/tsDMARDs-treated RA patients who have achieved low disease activity or remission. Although substantial literature data have revealed clinical utility of MSUS for monitoring disease activity and evaluating therapeutic response in RA patients, the evidence regarding its predictive value for the effectiveness of b/tsDMARDs is limited.
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Affiliation(s)
- Chia-Ching Chen
- Department of Physical Medicine and Rehabilitation, Taichung Tsu-Chi Hospital, Taichung, Taiwan
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Rheumatology and Immunology Center, Translational Medicine Laboratory, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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Leidersnaider CL, Sztajnbok FR, Coutinho ESF, Vaz JLP, Porangaba M, Hamdan PC, Martins PH, Constantino CPL, Ancillotti RV, Messeder AM, Monteiro DG, Folly MM, Mogami R. Chikungunya Fever: Comparison Study of Synovitis and Tenosynovitis of the Hands and Wrists Using Physical Examination, Ultrasound, and MRI Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:865-873. [PMID: 34170018 DOI: 10.1002/jum.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare musculoskeletal changes on a physical examination (PE), ultrasound (US) and magnetic resonance imaging (MRI) of the hands and wrists of patients with Chikungunya fever (CF). METHODS The sample consisted of 30 patients in the chronic phase of CF. The sites analyzed were the interphalangeal (IP), metacarpophalangeal (MCP) and wrist/mediocarpal (WMC) joints and periarticular soft tissue. The interval between the PE and imaging tests was 7 days, and the interval between US and MRI was 2 days. The kappa coefficient was calculated to estimate the agreement between the PE and US and MRI findings and between the US and MRI findings. RESULTS Significant agreement was observed between PE and US in the diagnosis of synovitis. The only statistically significant agreement between US and MRI was the finding of flexor tenosynovitis; the agreement was moderate. CONCLUSIONS US has great potential for use in diagnosing synovitis suspected based on a PE. The limited agreement observed between US and MRI, in turn, may suggest a complementary role of these methods.
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Affiliation(s)
| | | | | | - João Luiz Pereira Vaz
- Department of Rheumatology, Federal University of the State of Rio de Janeiro, Brazil
| | - Marina Porangaba
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Cesar Hamdan
- Department of Rheumatology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Mayara Malta Folly
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Roberto Mogami
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Sun C, Qi X, Yang Y, Lei L, Gao L, Guo H. Importance of baseline musculoskeletal ultrasound findings in the prognosis of rheumatoid arthritis. Clin Rheumatol 2022; 41:847-857. [PMID: 35041111 DOI: 10.1007/s10067-021-06017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/16/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the prognostic value of baseline musculoskeletal ultrasound (MSUS) findings for rheumatoid arthritis (RA). METHOD We retrospectively analyzed 138 patients with RA. Patients' first MSUS record was considered as the baseline expression. The subsequent MSUS changes that showed alleviation or progression were regarded as the cutoff point. Grayscale ultrasound (GSUS) synovitis, power Doppler ultrasound (PDUS) synovitis, PDUS tenosynovitis (TS), and bone erosion were scored using a semi-quantitative scale. According to the ultrasound (US) results of the cutoff point, patients were divided into the alleviation group and the progression group. Laboratory results (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], rheumatoid factor [RF], anticyclic citrullinated peptide [anti-CCP] antibody, and anti-keratin antibody [AKA]), disease activity score in 28 joints (DAS28)-ESR, and US scores were compared between the two groups to analyze the prognostic value of US findings in RA. RESULTS The alleviation group had higher levels of CRP, synovitis, TS, GSUS synovitis, PDUS synovitis, PDUS TS, and US total scores at baseline than the progression group (p < 0.05). The alleviation group received more aggressive treatment in their initial approach than the progression group (p < 0.05). The frequency of US examinations in the alleviation group was more than that in the progression group at follow-up (p < 0.05). Presence of baseline synovitis (OR 0.248, p = 0.006) and a higher GSUS synovitis score (OR 0.521, p = 0.006) were negatively correlated with RA progression. CONCLUSIONS Presence of baseline synovitis and higher GSUS synovitis score do not always indicate worse prognosis of RA, which can be improved with aggressive treatment. Regular MSUS follow-up may have positive influences on prognosis. Key Points • The presence of synovitis at baseline and higher GSUS synovitis score do not necessarily imply poor prognosis of RA. • Prompt and powerful therapy and regular ultrasound follow-up can slow down the progression of RA and improve its prognosis. • Patients with slight and less arthritis at baseline might be ignored and get worse prognosis due to mild treatment strategies and irregular MSUS examination.
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Affiliation(s)
- Chao Sun
- Department of Rheumatology and Immunology, the Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Xuan Qi
- Department of Rheumatology and Immunology, the Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Yushu Yang
- Department of Rheumatology and Immunology, the Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Lingyan Lei
- Department of Rheumatology and Immunology, the Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Lixia Gao
- Department of Rheumatology and Immunology, the Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China
| | - Huifang Guo
- Department of Rheumatology and Immunology, the Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei Province, China.
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Hèctor C, Millan AM, Diaz-Torne C. Rheumatoid Arthritis: Defining Clinical and Ultrasound Deep Remission. Mediterr J Rheumatol 2021; 31:384-388. [PMID: 33521569 PMCID: PMC7841096 DOI: 10.31138/mjr.31.4.384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/04/2022] Open
Abstract
The prognosis of patients with rheumatoid arthritis (RA) has improved substantially in the last two decades due to the appearance of biological therapies, but above all, due to the improvement in the strategy and management of the disease. Our goal in RA should be to achieve remission, or in its absence, the lowest inflammatory activity. Achieving remission will prevent from structural and functional damage highly associated with RA itself. Clinical remission is defined as the absence of significant signs and symptoms of inflammatory disease activity, as well as the abrogation of any signs of systemic inflammation. Currently, there are some controversies about remission. Which is the real remission? Which remission criteria should be used and when? Does clinical remission mean ultrasound remission? In the present review, we try to answer and put some light into it, focusing on clinical and ultrasound deep remission.
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Affiliation(s)
- Corominas Hèctor
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Milena Millan
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cesar Diaz-Torne
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
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Blanco FJ, Rubio-Romero E, Sanmartí R, Díaz-Torné C, Talavera P, Dunkel J, Naredo E. Clinical, Patient-Reported, and Ultrasound Outcomes from an Open-Label, 12-week Observational Study of Certolizumab Pegol in Spanish Patients with Rheumatoid Arthritis with or without Prior Anti-TNF Exposure. ACTA ACUST UNITED AC 2018; 16:345-352. [PMID: 30236749 DOI: 10.1016/j.reuma.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/18/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the effectiveness and safety of certolizumab pegol (CZP) in Spanish patients with RA. MATERIALS AND METHODS SONAR (NCT01526434), a 12-week, open-label, prospective, observational, multicenter study. Patients with active RA for ≥3 months, according to ACR criteria, were treated with CZP (400mg at Weeks 0, 2 and 4, then 200mg every 2 weeks). The primary effectiveness endpoint was change from baseline (CFB) in Health Assessment Questionnaire-Disability Index (HAQ-DI) at Week 12. Other assessments included DAS28(ESR), patient's assessment of arthritis pain (PtAAP-VAS) and Short Form 36-item Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS). Joint inflammation was investigated using Power Doppler (PD) ultrasound (US), to detect effusion, synovial hypertrophy and synovial PD signal. PDUS outcomes assessed CFB to Week 12 in synovial hypertrophy, effusion and PD signal indices. RESULTS A total of 77/80 enrolled patients received ≥1 dose of CZP. The 12-week mean reduction from baseline (SD) was -0.6 (0.6) for HAQ-DI and -2.2 (1.5) for DAS28(ESR). PtAAP-VAS was reduced from baseline (mean [SD]: -36.8 [26.8]) and improvements in SF-36 PCS and SF-36 MCS were reported. Synovial hypertrophy, effusion and PD signal indices were reduced from baseline to Week 12. One death was reported during the study. CONCLUSIONS Spanish patients with RA demonstrated improvements in clinical, PDUS and patient-reported outcomes over 12 weeks of CZP treatment. No new safety signals were identified, and the safety profile was in line with previous CZP studies. These results support previous clinical trial findings investigating CZP treatment for active RA.
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Affiliation(s)
| | | | | | | | | | | | - Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Fundación Jiménez Díaz, Madrid, Spain
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Mogami R, Pereira Vaz JL, de Fátima Barcelos Chagas Y, de Abreu MM, Torezani RS, de Almeida Vieira A, Junqueira Filho EA, Barbosa YB, Carvalho ACP, Lopes AJ. Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:511-520. [PMID: 28786505 DOI: 10.1002/jum.14344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening.
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Affiliation(s)
- Roberto Mogami
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - João Luiz Pereira Vaz
- Department of Rheumatology, Gafrée e Guinle University Hospital, Federal State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yêdda de Fátima Barcelos Chagas
- Department of Rheumatology, Gafrée e Guinle University Hospital, Federal State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mirhelen Mendes de Abreu
- Department of Rheumatology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Sperling Torezani
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - André de Almeida Vieira
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Yasmin Baptista Barbosa
- Department of Radiology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio Carlos Pires Carvalho
- Department of Radiology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programe in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Martín Noguerol T, Luna A, Gómez Cabrera M, Riofrio AD. Clinical applications of advanced magnetic resonance imaging techniques for arthritis evaluation. World J Orthop 2017; 8:660-673. [PMID: 28979849 PMCID: PMC5605351 DOI: 10.5312/wjo.v8.i9.660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) has allowed a comprehensive evaluation of articular disease, increasing the detection of early cartilage involvement, bone erosions, and edema in soft tissue and bone marrow compared to other imaging techniques. In the era of functional imaging, new advanced MRI sequences are being successfully applied for articular evaluation in cases of inflammatory, infectious, and degenerative arthropathies. Diffusion weighted imaging, new fat suppression techniques such as DIXON, dynamic contrast enhanced-MRI, and specific T2 mapping cartilage sequences allow a better understanding of the physiopathological processes that underlie these different arthropathies. They provide valuable quantitative information that aids in their differentiation and can be used as potential biomarkers of articular disease course and treatment response.
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Affiliation(s)
| | - Antonio Luna
- MRI Unit, Clínica Las Nieves, SERCOSA, Health Time, 23007 Jaén, Spain
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, United States
| | | | - Alexie D Riofrio
- Department of Radiology, Duke Regional Hospital, Durham, NC 27710, United States
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Ultrasound imaging of synovial inflammation in juvenile idiopathic arthritis. Pediatr Radiol 2017; 47:1160-1170. [PMID: 28779188 DOI: 10.1007/s00247-017-3934-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/05/2017] [Accepted: 06/23/2017] [Indexed: 01/17/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic entity of childhood. The hallmark feature of all subtypes is joint inflammation. Imaging is used to evaluate the extent and severity of inflammation, degree of joint damage and response to treatment, which in turn impacts patient management. Ultrasound has become a useful adjunct to clinical examination because it shows promise in evaluating clinical and subclinical inflammation (synovitis, enthesitis) as well as cartilage and bone erosive changes. However more collaborative research is needed to help define the normal appearance of the growing skeleton, clarify the significance of subclinical findings and develop useful definitions, imaging protocols and scoring systems of disease.
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