Background/Purpose: Ultrasound (US) is used to assess diseases activity in rheumatoid arthritis (RA). Gray scale (GS) US shows the synovial hypertrophy (SH) and Doppler the amount of hyperemia which is believed to reflect disease activity. Some joints with SH may have no Doppler activity despite the use of high-end US equipment and these joints are generally believed to be inactive without potential to change. The aim is to investigate if joints with SH but no Doppler activity is sensitive to change during treatment with biological DMARD (bDMARD) in RA patients

Methods:

RA patients initiating or changing bDMARD treatment were included. US examination was performed at baseline, 3 and 6 months using Siemens Antares US equipment with Doppler settings for slow flow. 36 joints were evaluated at each visit. SH and Doppler activity was graded from 0-3 according to the US atlas by Hammer et al. The GS score for SH in joints without Doppler activity was registered for the individual joints using GS SH>1 as threshold. The changes were compared to changes in SH in joints with Doppler activity.

Results:

157 patients (83.2% women, 81.3% seropositive for anti-CCP and 75.8% for rheumatoid factor) were included, with a mean (SD) age of 51.5 (13.3) years and mean disease duration of 9.9 (8.1) years. At baseline, 52.2% used prednisolone (mean (SD) 7.7 (4.6) mg, range 2.5-25mg). The patients had a mean (SD) baseline DAS28 of 4.5 (1.5). At baseline 27% of the joints had SH without Doppler activity and 28% of the joints had SH with Doppler activity. Joints without Doppler had overall lower grades of SH (mean 0.72) than joints with Doppler (mean 1.21).

Of the joints that had SH without Doppler at baseline, 54% had a decrease in SH at 3 months, and 56% at 6 months. For joints with SH with Doppler at baseline, 52% had a decrease in SH at 3 months, and 60% at 6 months. The overall proportion of joints improving in SH was similar in joint with and without Doppler activity but when adjusting for the baseline score of SH, SH in joints without Doppler activity had a higher tendency towards decrease than those with Doppler activity (3 months: p <0.0001; 6 months < 0.0005).

Conclusion:

SH in joints without Doppler activity improves during bDMARD, i.e is sensitive to change. Thus, SH without Doppler activity is not a sign of inactive disease. These findings document that both Doppler and SH should be evaluated when assessing disease activity by US.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-synovial-hypertrophy-without-doppler-activity-in-rheumatoid-arthritis-joints-sensitive-to-change-results-of-a-longitudinal-ultrasound-study/