scholarly journals POS0661 RAPID RESPONSE TO BARICITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS AND AN INADEQUATE RESPONSE TO METHOTREXATE AND AT LEAST ONE BIOLOGIC DMARD: A CLINICAL AND POWER DOPPLER ULTRASOUND STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 573.1-573
Author(s):  
C. Baldi ◽  
P. Falsetti ◽  
E. Conticini ◽  
S. G. Khayyat ◽  
M. Bardelli ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Doppler Ultrasound ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Power Doppler Ultrasound ◽  
Short Term ◽  
Synovial Hyperplasia ◽  
Term Efficacy

Background:Baricitinib, an oral Janus kinase (JAK) 1-2 inhibitor, is currently used among biologic DMARDs (bDMARDs) after the failure of methotrexate (MTX) in rheumatoid arthritis (RA). Power Doppler ultrasound (PDUS) is a promising, non-invasive imaging method to assess synovitis in RA: results from numerous studies suggest that it provides additional information to clinical and conventional radiographic examinations.Objectives:The main objective of our study was to evaluate short-term efficacy of Baricitinib in reducing synovitis, using the composite semi quantitative scale (0–3 grades) PDUS synovitis score, developed by the Outcome Measures in Rheumatology– European League Against Rheumatism (OMERACT– EULAR)-Ultrasound Task Force. Moreover both synovial hyperplasia and intrasynovial power Doppler (PD) signal were also scored as single components/parameters on 0-3 scales. Secondary objective was to assess the concordance between patient reported outcomes (PROs), markers of inflammation, physical examination and US.Methods:We enrolled 30 patients fulfilling 2010 ACR and EULAR criteria for RA. All patients had failed at least one anti-TNF. Each patient was prescribed Baricitinib 4 mg/daily at T0, in addition to MTX and/or oral steroids at a dosage ≤ 7, 5 mg/day of Prednisone or equivalent, at T’. All patients were evaluated at baseline (T0) and then after one month (T1), 3 months (T2) and 6 months (T3) of treatment. Swollen and tender joints (out of 28)were evaluated and recorded, as well as patient (PGA) and physician global assessment (PhGA) and pain, expressed in a visual analog scale (VAS). Disease activity was evaluated at each visit using DAS28 (Disease activity score 28), CDAI (Clinical disease activity index)and SDAI(Simplified disease activity index), accompanied by a complete blood count, Erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) collection. Statistical analysis was performed using GraphPad version 9.0.0. PDUS examination, was carried out by two rheumatologists (PF and CB) blinded to clinical conditions of the patients, using an Esaote Mylab Twice (Genoa, Italy), equipped with a high-frequency (6-18 MHz) linear probe. With standardised Doppler parameters (pulse repetition frequency between 500-750 Hz; Doppler frequency between 7–11.1 MHz). PDUS was performed at each visit bilaterally for 22 joint sites [MCPs 1–5, proximal interphalangeal joints (PIPs) 1–5, wrist, elbow, glenohumeral, knee, tibiotalar, talonavicular and calcaneocuboidal and metatarsophalangeal joints (MTPs) 1–5] for a total of 44 joints for each patient.Results:we observed a reduction of VAS pain (T0 vs, T6<0,0001) PDUS composite score (T0 vs. T6 p<0,0001), Power Doppler (T0 vs. T6 p<0,0001) synovial hyperplasia (T0 vs. T6 p=0,0002), CRP (T0 vs. T6 p<0,0001) and ESR (T0 vs. T6 p <0,0001) was observed in our patients. Accordingly, DAS-28, CDAI and SDAI displayed a significant reduction too (DAS-28: T0 vs. T6 p< 0, 0001; CDAI: T0 vs. T6 p< <0, 0001; SDAI: T0 vs. T6 p= 0, 0003).Conclusion:We investigated the efficacy of Baricitinib in real life, evaluating both from a clinimetric and ultrasound point of view. Baricitinib, demonstrated a significant parallel and fast improvement in VAS, PDUS and CRP was found at follow up assessment as early as one month of therapy. In conclusion, these results demonstrated the short term efficacy of Baricitinib 4mg for up to 6 months and providing a prompt improvement of PROs within the first weeks of treatment.Figure 1.The difference between the means of PD and of the VAS pain over time (T0, T1, T3 and T6). Power Doppler (T0 vs. T6** p<0,0001), VAS: (T0 vs. T1 *p<0,0098;T0 vs. T3 **** p<0,0001; T0 vs. T6 ****p<0,0001)Disclosure of Interests:None declared

POWER DOPPLER ULTRASOUND FEATURESOF WRIST JOINTS IN RHEUMATOID ARTHRITIS

2018 ◽  
Vol 8 (3) ◽  
pp. 90-94
Author(s):  
Quang Luc Nguyen ◽  
Hoang Thanh Van Nguyen ◽  
Hoang Minh Nguyen
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Doppler Ultrasound ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Tender Joint Count ◽  
Power Doppler Ultrasound ◽  
Grey Scale ◽  
Wrist Joints

Background and aims: Assessments of disease activity in rheumatoid arthritis plays an important role in determining treatment plans and patient response to treatment. The aims of this study was to describe the power Doppler ultrasound features of wrist joints in patients with rheumatoid arthritis and evaluate role of power Doppler ultrasoundin assessing disease activity in patients withrheumatoid arthritis. Material and method: This present study included 30patients diagnosed with rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria, who were admitted in the period July 2017 to April 2018 in Department of Nephrology and Rheumatology, Hue Central Hospital. All patients were physical examination, laboratory investigations, assessment disease activity score in 28 joints using CRP (DAS28-CRP), clinical disease activity index (CDAI), simplified disease activity index (SDAI). Grey scale ultrasound and power Doppler ultrasound were used to assess synovitis, effusion and tenosynovitis and synovial vascularity of 60 wrist joints. Power Doppler was graded using a validated semiquantitative scroring system, which consists of scale of 0-3. Result: Twenty-seven wrist joints (45.0%) had synovitis in grey scale ultrasound. Thirty-seven wrist joints (61.7%) had a power doppler signal, 18.3% had grade 1 (low), 21.7% had grade 2 (moderate) and 21.7% had grade 3 (high). Level of angiogenesis in PDUS with semiquantitative scroring systemweresignificantly correlated with tender joint count, swollen joint count, global VAS, CRP and CDAI, SDAI, DAS28-CRP. Conclusions: Power Doppler ultrasound of wrist joints could be used as a non-invasive and feasible method to assessing disease activity in patients with rheumatoid arthritis. Key words: rheumatoid arthritis, power Doppler ultrasound

scholarly journals Clinical and ultrasound remission after 6 months of treat-to-target therapy in early rheumatoid arthritis: associations to future good radiographic and physical outcomes

2018 ◽  
Vol 77 (10) ◽  
pp. 1421-1425 ◽  
Author(s):  
Nina Paulshus Sundlisæter ◽  
Anna-Birgitte Aga ◽  
Inge Christoffer Olsen ◽  
Hilde Berner Hammer ◽  
Till Uhlig ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Radiographic Progression ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Treat To Target ◽  
Good Outcome ◽  
Grey Scale

ObjectiveTo explore associations between remission, based on clinical and ultrasound definitions, and future good radiographic and physical outcome in early rheumatoid arthritis (RA).MethodsNewly diagnosed patients with RA followed a treat-to-target strategy incorporating ultrasound information in the Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen (ARCTIC) trial. We defined 6-month remission according to Disease Activity Score, Disease Activity Score in 28 joints-erythrocyte sedimentation rate, American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean criteria, Simplified Disease Activity Index, Clinical Disease Activity Index and two ultrasound definitions (no power Doppler signal, grey scale score ≤2). Two outcomes were defined: no radiographic progression and good outcome (no radiographic progression+physical function≥general population median), both sustained 12–24 months. We calculated the ORs of these outcomes for the remission definitions.ResultsOf 103 patients, 42%–82% reached remission at 6 months, dependent on definition. Seventy-one per cent of patients had no radiographic progression and 37% had good outcome. An association between 6-month remission and no radiographic progression was observed for ACR/EULAR Boolean remission (44 joints, OR 3.2, 95% CI 1.2 to 8.4), ultrasound power Doppler (OR 3.6, 95% CI 1.3 to 10.0) and grey scale remission (OR 3.2, 95% CI 1.2 to 8.0). All clinical, but not ultrasound remission criteria were associated with achievement of a good outcome.ConclusionsOur data support ACR/EULAR Boolean remission based on 44 joints as the preferred treatment target in early RA. Absence of ultrasound inflammation was associated with no radiographic progression.Trial registration numberNCT01205854; Post-results.

scholarly journals Estimation of a numerical value for joint damage-related physical disability in rheumatoid arthritis clinical trials

2009 ◽  
Vol 69 (6) ◽  
pp. 1058-1064 ◽  
Author(s):  
Josef S Smolen ◽  
Daniel Aletaha ◽  
Johannes C Grisar ◽  
Tanja A Stamm ◽  
John T Sharp
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Health Assessment ◽  
Joint Damage ◽  
Disease Activity Index ◽  
Controlled Clinical Trial ◽  
Short Term ◽  
Randomised Controlled ◽  
Radiographic Changes

BackgroundJoint damage is an important outcome in trials of rheumatoid arthritis (RA), usually assessed by Total Sharp Score (TSS). It is currently unknown how it translates numerically into disability by the Health Assessment Questionnaire (HAQ).ObjectiveTo determine the units of HAQ score corresponding to one TSS unit.MethodsA short-term observational trial of glucocorticoids in RA (the ‘BEst LIfe with Rheumatoid Arthritis’ (BELIRA) trial) was evaluated, using randomised controlled clinical trial (RCT) data for confirmation. For each trial arm HAQ, TSS and the Simplified Disease Activity Index (SDAI) were assessed. Based on the hypothesis that short-term HAQ changes will mostly be due to changes of disease activity, activity HAQ (ACT-HAQ) at end point (EP) was determined and remaining disability defined as damage related (DAM-HAQ). Using TSS at EP, the HAQ units corresponding to a TSS unit were estimated.ResultsIn BELIRA, one TSS unit corresponded to a mean of 0.017 HAQ units; to account for other causes of irreversible disability, the 25th percentile was used: 0.011 HAQ units/TSS unit. In RCT trial arms, the HAQ/TSS were similar (0.013 and 0.015 in established and early RA, respectively; 25th percentile: 0.010). The correlation between DAM-HAQEP and TSS was r=0.829. Over 5 years, damage would amount to an increase of irreversible HAQ of 0.33 on placebo, 0.13 on disease-modifying antirheumatic drugs (DMARDs) and 0.03 on TNF inhibitors+methotrexate (MTX).ConclusionAn approach to estimate the numerical relationship between HAQ and damage as 0.01 HAQ points/TSS unit is presented, although the linear relationship may not be generally valid. This allows the assessment of functional correlates of radiographic changes in trials.

The correlation between ultrasound-detected synovitis of small joints and the clinical disease activity in patients with rheumatoid arthritis

2020 ◽  
Author(s):  
Xuerong Deng ◽  
Xiaoying Sun ◽  
Wenhui Xie ◽  
Yu Wang ◽  
Zhuoli Zhang
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Clinical Disease ◽  
Joint Involvement ◽  
Clinical Disease Activity ◽  
Hands And Feet ◽  
Activity Indices

Abstract Background: Rheumatoid arthritis (RA) is chronic inflammatory arthritis with multi-joint involvement, especially small synovial joints in hands and feet. So far, the synovitis of which joint in hands or feet is better correlated with clinical disease activity indices is unknown; the correlation of synovitis detected by ultrasound in an individual joint with global disease activity is unclear either.Objectives: To explore the correlation between the ultrasound-detected synovitis in metacarpophalangeal (MCP), metatarsophalangeal (MTP), proximal interphalangeal (PIP) joints and the clinical disease activity indices in patients with RA.Methods: 30 joints, including bilateral MCP, PIP and MTP, were scanned for synovitis by ultrasound, semi-quantitatively scored for gray scale(GS) and power Doppler(PD). The correlation between Disease Activity Score-28 joints(DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and ultrasound-detected synovitis score in each joint was assessed using Spearman’s rank correlation test. Results: 211 RA patients were included in this study. The whole GS scores of all MCP joints showed highest correlation with all clinical disease activity indices (r=0.403-0.452, p<0.01), followed by PIPs (r=0.318-0.331, p<0.01) and MTPs (r=0.277-0.301, p<0.01). Likewise, the whole PD scores of all MCP joints also showed highest correlation with the disease activity (r=0.332-0.396, p<0.01), followed by PIPs (r=0.211-0.242, p<0.01), and MTPs (r=0.198-0.222, p<0.01). The highest correlation of GS score with DAS28-ESR (r=0.411, p<0.01), DAS28-CRP (r=0.459, p<0.01), SDAI (r=0.444, p<0.01) was observed in MCP3 joint, while with CDAI (r=0.421, p<0.01) in MCP2 joint. The highest correlation of PD score with DAS28-ESR (r=0.353, p<0.01), DAS28-CRP (r=0.399, p<0.01), CDAI (r=0.368, p<0.01), SDAI (r=0.377, p<0.01) was in MCP5 joint. Conclusions: The ultrasound-detected synovitis at MCP joints, especially MCP2, MCP3, and MCP5 joints, was best correlated with composite disease activity of RA, in contrast to PIP and MTP joints. MCP joints should take greater weight in clinical disease activity assessment.

scholarly journals Ultrasound and multi-biomarker disease activity score for assessing and predicting clinical response to tofacitinib treatment in patients with rheumatoid arthritis

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Amir A. Razmjou ◽  
Jenny Brook ◽  
David Elashoff ◽  
Gurjit Kaeley ◽  
Soo Choi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Clinical Response ◽  
Disease Activity Score ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Response To Therapy ◽  
Activity Score ◽  
Linear Regression Models

Abstract Background Musculoskeletal ultrasound (MSUS) and the multi-biomarker disease activity (MBDA) score are outcome measures that may aid in the management of rheumatoid arthritis (RA) patients. This study evaluated tofacitinib response by MSUS/MBDA scores and assessed whether baseline MSUS/MBDA scores or their early changes predict later clinical response. Methods Twenty-five RA patients treated with tofacitinib were assessed at baseline, 2, 6 and 12-weeks. Power doppler (PDUS) and gray scale (GSUS) ultrasound scores, MBDA score, clinical disease activity index (CDAI), and disease activity score (DAS28) were obtained. Pearson correlations and multiple linear regression models were used to evaluate associations and identify predictors of response to therapy. Results MSUS, MBDA scores, CDAI, and DAS28 improved significantly over 12 weeks (p < 0.0001). Baseline MSUS and MBDA score correlated with each other, and with 12-week changes in CDAI/DAS28 (r = 0.45–0.62, p < 0.05), except for GSUS with DAS28. Two-week change in MSUS correlated significantly with 12-week changes in CDAI/DAS28 (r = 0.42–0.57, p < 0.05), except for early change in PDUS with 12-week change in CDAI. Regression analysis demonstrated significant independent associations between baseline PDUS/MBDA score and 6-week change in CDAI/DAS28, with adjustment for baseline CDAI/DAS28 (all p < 0.05); and between baseline MBDA scores and 12-week change in DAS28 (p = 0.03). Conclusions RA patients treated with tofacitinib for 12 weeks demonstrated improvement by clinical, imaging, and biomarker end-points. Baseline PDUS and MBDA score were predictive of CDAI and DAS28 responses. This is the first study to evaluate early measurements of MSUS and MBDA score as predictors of clinical response in RA patients treated with tofacitinib. Trial registration ClinicalTrials.gov NCT02321930 (registered 12/22/2014).

The Value of Power Doppler Ultrasound in Patients With Rheumatoid Arthritis in Clinical Remission: Reclassifying Disease Activity?

2018 ◽  
Vol 14 (4) ◽  
pp. 202-206
Author(s):  
Facundo Vergara ◽  
Santiago Ruta ◽  
Javier Rosa ◽  
Josefina Marín ◽  
Ricardo García-Mónaco ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Doppler Ultrasound ◽  
Clinical Remission ◽  
Power Doppler ◽  
Power Doppler Ultrasound

Ultrasound of Synovitis in Rheumatoid Arthritis: Advantages of the Dorsal over the Palmar Approach to Finger Joints

2014 ◽  
Vol 41 (3) ◽  
pp. 422-428 ◽  
Author(s):  
Matthias N. Witt ◽  
Felix Mueller ◽  
Peter Weinert ◽  
Axel P. Nigg ◽  
Christiane S. Reindl ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Power Doppler ◽  
Disease Activity Index ◽  
Double Positive ◽  
Dorsal Approach ◽  
Clinical Variables ◽  
Finger Joints ◽  
Palmar Approach

Objective.To compare the dorsal and palmar ultrasound (US) examination of finger joints in early rheumatoid arthritis (RA) with regard to the concurrence of greyscale (GSUS) and power Doppler (PDUS) positivity, and to correlate both approaches with clinical variables.Methods.Patients with newly diagnosed RA were assessed by clinical examination and US. GSUS and PDUS of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were performed using the dorsal and palmar approach. Findings of synovitis in GSUS and PDUS were graded semiquantitatively from 0 to 3. Clinical and sonographic reevaluation was performed after 6 months.Results.With 44.6% versus 32.2% positive findings, palmar GSUS identified significantly more joints with synovitis than did dorsal GSUS. With 22.1% versus 8.9%, PDUS abnormalities were detected significantly more often from the dorsal side. With 71.2% versus 21.8% for the MCP and 57.5% versus 17.4% for the PIP joints, significantly more GSUS and PDUS double-positive joints were found with the dorsal as opposed to the palmar approach. These differences remained significant at Month 6. Both palmar and dorsal GSUS and PDUS correlated with comparable strength with clinical variables such as the Disease Activity Score 28, Clinical Disease Activity Index, and Simple Disease Activity Index.Conclusion.Although the dorsal approach detected fewer GSUS findings than the palmar approach, PDUS signals were significantly more frequently detected by dorsal US. In addition, the prevalence of double-positive joints with concurrent GSUS and PDUS findings was significantly higher with the dorsal approach. These data argue in favor of the dorsal US approach to finger joints in RA.

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