Value of ultrasound indices for the assessment of rheumatoid arthritis activity and tocilizumab therapy efficiency

Objective: to estimate the value of simplified ultrasound (US) indices of synovitis in the most commonly involved joints of the dominant hand, which are studied using the grey scale mode while monitoring the efficiency of tocilizumab (TCZ) therapy in patients with rheumatoid arthritis (RA). Subjects and methods. Forty-six patients with RA confirmed by the 1987 American College of Rheumatology (ACR) criteria who had been ineffectively treated received TCZ infusions for 6 months. The patients were stratified into two groups: 1) 11 patients with early (<2-year) RA (ERA); 2) 35 patients with protracted (>2-year) RA (PRA). Disease activity and therapy efficiency were determined by DAS28-CRP, SDAI, and US study of the dominant hand joints most commonly involved in the pathological process. Results. The evaluation of TCZ therapy from the simplified US indices reflected synovitis regression in the dominant hand joints of patients with ERA. The highly significant correlations between the changes in US parameters and RA activity the indices ^US-wrist/iDAS28-CRP: r = 0.75; p = 0.01; ΔUS-S8/ΔDAS28-CRP and ΔUS-S5/ΔSDAI: r = 0.65; p < 0.05) confirm the validity of the above changes. No reduction in the joint indices was observed in the patients with PRA. Conclusion. The simplified grey-scale US indices of synovitis in the joints of the dominant hand (including one wrist joint) is an accessible noninvasive method for evaluating the efficiency of the therapy performed in patients with ERA

EVALUATION OF THE EFFICIENCY OF TOCILIZUMAB THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS BY ULTRASOUND AND X-RAY DATA

Objective: to estimate the time course of changes in the ultrasound signs of wrist joint synovitis in patients with rheumatoid arthritis (RA) during tocilizumab (TCZ) treatment and to determine whether the progression of joint X-ray changes can be predicted by ultrasonography (USG). Subjects and methods. The investigation enrolled 46 patients with the diagnosis of RA that met the American College of Rheumatology 1987 criteria. All the patients were given TCZ during insufficiently effective previous therapy (median DAS28 was 6.7 [range 5.9—7.2]). They were divided into 2 groups: 1) early RA (ERA) with a disease history of less than 2 years (n = 11); 2) RA with a history of over 2 years (n = 35). Hand USG (Voluson-i GE, USA) with a 4—13-MHz linear probe using an energy Doppler (ED) was carried out before and 6 months after therapy. Structural changes were evaluated by hand and foot X-ray study (before and at 12-month follow-up) according to the Sharp method modified by van der Heide. Results. Dynamic evaluation of the ultrasound signs of inflammation indicated a significant reduction in the magnitude of synovitis in accordance with the gray-scale data in both groups and only in the patients with ERA in the ED mode. There was a clear association of the annual increment in joint X-ray changes with the result of estimation of the magnitude of synovitis according to the ED data (r = 0.669; p < 0.01). Conclusion. Wrist joint sonography allows evaluation of the efficiency of the performed therapy in patients with RA and the presence of moderate or severe synovitis, as evidenced by ED, is a predictor for the progression of joint destruction

Significance of arthrosonography in the diagnosis of metatarsophalangeal joint injury in patients with rheumatoid arthritis

Objective: to estimate the contribution of arthrosonography to the diagnosis of metatarsophalangeal joint (MTPJ) injury and to reveal predictors for functional impairments in patients with rheumatoid arthritis (RA). Subjects and methods. The investigation enrolled 50 patients with the RA diagnosis meeting to the American College of Rheumatology 1987 criteria. According to disease duration, the patients were divided into two groups: 1) 9 patients with an early RA history of less than 2 years (ERA); 2) 41 patients with a RA history of over 2 years (LRA). All the patients underwent clinical joint evaluation, laboratory and instrumental examination, including joint X-ray and ultrasonography (USG). Results. An inflammatory process in the foot joints is significantly more frequently detected on ultrasound than clinically (p < 0.0001). The detection rate of erosions, as evidenced by USG, was significantly higher than that by X-ray, in ERA in particular (p = 0.01). Comparison analysis of patients with low and high HAQ scores showed the relationship between functional status, age, pain degree, and inflammatory process in the fifth MTPJ, as shown by USG. There were no associations with disease duration, traditional clinical and laboratory parameters of RA activity, and erosive changes in the feet. Conclusion. Joint USG in daily clinical practice makes it possible to objectively evaluate pathological changes in the feet and the probability of work disability due to RA

EVALUATION OF ULTRASOUND REMISSION CRITERIA IN PATIENTS WITH RHEUMATOID ARTHRITIS DURING TOCILIZUMAB THERAPY

Objective: to study the association of ultrasound (US) remission criteria with the clinical and laboratory indicators of inflammatory activity, functional status, and X-ray changes in patients with rheumatoid arthritis (RA) during tocilizumab (TCZ) therapy.Subjects and methods. The trial included 36 patients with RA (meeting the 1987 American College of Rheumatology (ACR) criteria) who had received TCZ for 6 months. The authors made a clinical and laboratory assessment of RA activity (DAS28-CRP, and SDAI), functional impairments (HAQ index) and US verification of wrist joint synovitis (a Voluson-i device, GE, 4-13-MHz linear transducer) at baseline and 6 months after therapy. No signs of grey-scale (B-mode) and power Doppler (PD) synovitis (B = 0; PD = 0) or minimal B-mode synovitis, and not more one PD hypervascular signal (В ≤1; PD ≤1) were arbitrarily taken as US remission criteria. Destruction changes were evaluated by hand and foot X-ray using the Sharp method modified by van der Heijde (SHS).Results. After 6 months of therapy, about 80% of the patients in clinical remission retained moderate or significant synovitis, as evidenced by US studies. There were no clinical differences in clinical activity indices and functional impairments between the patients who were and were not in US remission (p > 0.05). The 12-month follow-up SHS score was significantly higher with the preservation of 6-month therapy signs of B-mode synovitis and PD hypervascularization (of not more than one signal) than that in US remission (p < 0.05). There was no relationship of X-ray progression to the clinical and functional statuses (p > 0.05).Conclusion. Subclinical synovitis is observed even in clinical remission of RA. Destruction progression is significantlyrelated to synovitis persistence, as shown by ultrasonography

Evaluation of the structural changes of the hand joints and the rates of rheumatoid arthritis progression according to ultrasound data

Objective: to define the significance of ultrasonography (USG) in the diagnosis of early destructive changes in the hand joints and the rates of rheumatoid arthritis (RA) progression in patients at different ages of disease onset. Subjects and methods. 100 patients with a valid RA diagnosis (American College of Rheumatology (ACR) 1987 criteria were examined. They were divided into 2 groups: 1) 11 patients with an early RA history of less than 2 years (ERA); 2) 35 patients with a RA history of over 2 years (LRA). Hand USG (Voluson-i GE; a 4-13-MHz linear probe; gray scale mode) was carried out at baseline and after 6-month follow-up. A sonographic index (US-Er-10) based on the bilateral evaluation of 5 articular areas, such as wrinkles, second-to-third metacarpophalangeal (MCP) and second-to-third proximal interphalangeal (PIP) joints, was proposed to evaluate the progression of destruction. According to US-Er-10 changes, the rates of development of the destructive process were arbitrarily separated into three categories: 1) slow progression rate; 2) moderate progression rate; 3) a rapidly progressive course. The X-ray parameters of structural progression were estimated at 12-month follow-up, by employing the Sharp method modified by van der Heide (SHS). Results. The USG versus X-ray detection rate of erosions was significantly higher in both ERA and LRA (p < 0.05). The ERA patients who had fallen ill after 55 years of age were found to have more significant baseline and final destructive changes according to a total SHS score (p < 0.05) and US-Er-10 index (p < 0.005) than those with RA onset at a younger age. In the ERA patients in whom US-Er-10 increased by three points or more at 6-month follow-up, the rates of X-ray progression at 12 months were significantly higher than those with less pronounced negative changes in this index (Δ total SHS score of 13.5 [3-23] and 0 [0-0], respectively; p < 0.05). The LRA group displayed no statistically relationships between the USG rate of erosion progression and the time course of X-ray changes and laboratory evidence. Conclusion. Hand USG reveals early erosive joint changes significantly more frequently than X-ray study and the high progression rate of destruction according to USG and the disease with onset after 55 years of age are associated with its severer course and poor prognosis in patients with ERA