Musculoskeletal Ultrasonography May Aid in RA Treatment Optimization

Musculoskeletal ultrasonography assessments may aid in optimizing rheumatoid arthritis (RA) treatment and patient care, findings of a new study show.

The determination comes after the researchers found that such assessments can be useful in detecting subclinical levels of inflammation and predicting future joint deterioration among patients with moderate to severe RA requiring a treatment change due to lack of efficacy.

To assess the effectiveness of musculoskeletal ultrasonography as a disease management tool, the researchers analyzed data on patients who had been managed with musculoskeletal ultrasonography (n=171) or routine care (n=212) for 1 year.

At baseline, a greater proportion of patients in the musculoskeletal ultrasonography group (50.3%) than in the routine care group (36.8%) had received biologic disease-modifying antirheumatic drug (bDMARD) treatment. Meanwhile, more patients in the routine care group (91.5%) than in the musculoskeletal ultrasonography group (84.2%) had received non-bDMARD treatment.

Compared with the routine care group, the musculoskeletal ultrasonography had a greater number of RA treatment modifications during follow-up (adjusted incidence rate ratio of 1.41). The difference in the number of modifications was seen with steroids, non-bDMARDs, and bDMARDs. 

The 2 groups showed no significant differences in clinical outcomes, including for Clinical Disease Activity Index/Disease Activity Score-28 with Erythrocyte Sedimentation Rate remission and low disease activity, or patient-reported outcomes.  

However, among patients in the musculoskeletal ultrasonography group in clinical remission, 50% to 80% had a musculoskeletal ultrasonography score of 1 or greater, and 37% to 73% had an erosion score of 1 or more. 

During follow-up, the researchers found significant associations between baseline synovitis and joint erosion.

“[Musculoskeletal ultrasonography] is a valuable point-of-care noninvasive imaging tool that can accurately evaluate [intra-articular] and periarticular structures involved in rheumatic diseases,” the researchers wrote. “[Greyscale] and power Doppler have been found to be more sensitive in detecting synovitis than clinical examination and to be predictive of joint deterioration, which has been confirmed in our study.” 

“Future studies should focus on identifying patient subgroups that would benefit the most from a routine use of [musculoskeletal ultrasonography],” the researchers concluded.

—Colleen Murphy

Reference:

Stein M, Vaillancourt J, Rampakakis E, Sampalis JS. Prospective observational study to evaluate the use of musculoskeletal ultrasonography in rheumatoid arthritis management: the ECHO study. Rheumatology (Oxford). 2020;59(10):2746-2753. doi:10.1093/rheumatology/keaa004