Background/Purpose: It is known that ultrasound (US) is a useful test to monitor rheumatoid arthritis (RA) patients. However, to date, no study has shown the US parameters to be able to predict treatment failure in RA patients.Thus the aim of the present study was to evaluate the findings of a new ultrasound score (US10) of the hand and wrist joints (US10) to predict treatment failure in early RA patients.

Methods: A 12-months cohort study was carried out in patients with early RA, with less-than-1 year symptom with no previous use of disease-modifying antirheumatic drugs (DMARD). The patients underwent clinical, laboratory assessment and blinded US examination (US10) at baseline, 3, 6, 9 and 12 months. The US10 included the following joints:  wrist, second and third metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. This score was composed by the following parameters, a first one was according to inflammation: a qualitative (0-1) and semi-quantitative(0-3) scoring to synovial proliferation(SPQ10,SPSQ10) and to power Doppler (PD) (PDQ10,PDSQ10), and qualitative (0-1) gray scale and PD scores for tenosynovitis/paratendinosis (GSTN10, PDTN). A second US finding was categorised according to joint damage: a qualitative (0-1) and semi-quantitative(0-3) scoring to bone erosions (ERQ10, ERSQ10) and to cartilage damage (CAQ10, CASQ10).All patients were treated by a single rheumatologist following similar treatment protocol performed according to clinical activity criteria of the joint 28-Disease Activity Score (DAS 28) and the Physician’s Global Assessment (AGM). Three treatment failures were observed over these 12 months: first DMARD failure (Failure 1), a second DMARD failure (Failure 2) and a first immunobiological failure (Failure 3).

Results: 48 patients completed the study, and 41 (85.41%) had  Failure 1, 25 (52%) had a Failure 2 and five (10.5%) patients had a Failure 3. The respective PDQ10 baseline was a predictor for Failure 1 and Failure 2 with the following cutoff values: 2.5 (S = 87.8%, E = 71.42%, PPV = 94.7% and NPV = 50%) and 4.5 (S = 84%, E = 47.82%, PPV = 63.6% and NPV=73.3%). The PDSQ10 baseline was also a predictor for Failures 1 and 2 with the respective cutoff values: 5.0 (S = 90.2%, E = 71.4%, PPV = 94.9% and NPV = 55.6 %) and 9.5 (S = 84%, E = 47.82%, PPV = 63.6% and NPV 73.3%). Furthermore, there was an increase in 1.47 and 1.19 OR per unit increase in score PDQ10 to predict Failures 1 and 2 (p<0,005). The PDSQ10 at baseline also showed an OR of 1.18 and 1.7 (95%, p <0.005) to predict failure for the first and second DMARD, respectively.

Conclusion:

US10, with the PDQ10 and PDSQ10 parameters was found to be useful to predict the first and second DMARD failure in early RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/power-doppler-is-predictive-of-treatment-failure-in-early-rheumatoid-arthritis-patients-a-one-year-follow-up-study/