Background/Purpose: Previous studies, including TASER and ARTIC (1,2), failed to demonstrate a significant benefit of ultrasound (US) compared to clinical evaluation in achieving clinical remission or slowing structural progression in rheumatoid arthritis (RA). Despite these findings, the role of US in the follow-up of RA patients remains debated. This study aimed to determine whether radiographic progression at 1 year (primary end point) and 2 years, differs in RA patients followed by rheumatologists aiming for remission without synovitis (including the 28 articulations included in the SDAI and the 10 MTPs), using either Doppler-mode US, B-mode US, or clinical evaluation alone.

Methods: The BCD study (NCT02410304) was a prospective, multicenter, randomized, pragmatic clinical trial conducted across 10 hospitals in France from 2014 to 2018. RA patients, diagnosed with RA according to the 2010 ACR/EULAR criteria and on stable treatment, were randomized in a 1:1:1 ratio. Patients were followed every 3 months for 1 year with a remission target (no synovitis, no painful joints, patient visual analog scale ≤1/10, and normal C-reactive protein) assessed through:1. D-mode US: Doppler evaluation of 38 joints (10 PIP, MCP, 2 wrists, 2 elbows, 2 shoulders, 2 knees, 10 MTP).2. B-mode US: A combination of clinical evaluation for 26 joints and B-mode US for MTP and shoulders.3. C-mode: Clinical evaluation only.All patients underwent US and radiographic assessments (Sharp-van der Heijde scores: SvHD) at baseline, 12 months, and 24 months. Radiographic progression, the primary endpoint, was defined as an increase of >1 point in the SvHD score at 12 months. Between-group comparisons of radiographic evolution were conducted using a generalized linear model with binary distribution and log link, adjusted for center as a random effect.

Results: 545 patients were randomized, and 513 were analyzed at 12 months (169 C-mode, 171 B-mode, 173 D-mode). Baseline characteristics were similar across groups. Mean age was 58.12 (12.05 SD) years and mean RA duration was 11.79 (9.89 SD) years. 41.9% of patients were in remission according DAS-CRP. Radiographic progression ( >1 point increase in Sharp score) at 12 months did not significantly differ between groups (Table 1). In contrast, B-mode US was associated with a higher proportion of global high radiographic progression compared to C-mode at 24 months.

Conclusion: Although US detect more synovitis than clinical evaluation, neither D-mode nor B-mode US guided therapy slowed radiographic progression during follow-up compared to clinical evaluation guided therapy alone.REFERENCES: Haavardsholm EA, Aga AB, Olsen IC, Lillegraven S, Hammer HB, Uhlig T, et al. Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial. BMJ. 16 août 2016;i4205.Dale J, Stirling A, Zhang R, Purves D, Foley J, Sambrook M, et al. Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial. Ann Rheum Dis. juin 2016;75(6):1043‑50.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/at-the-patient-level-ultrasound-evaluation-during-the-follow-up-of-rheumatoid-arthritis-does-not-modify-radiographic-evolution-a-prospective-multicenter-randomized-pragmatic-clinical-trial-bcd-s/