Skip to main content

Advertisement

SpringerLink
Log in

Improvement of large-joint ultrasonographic synovitis is delayed in patients with newly diagnosed rheumatoid arthritis: results of a 12-month clinical and ultrasonographic follow-up study of a local cohort

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

We analyzed the longitudinal changes in gray-scale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS) parameters and correlated them with clinical, functional, and radiologic outcomes in patients with newly diagnosed rheumatoid arthritis (RA). GSUS and PDUS examinations, 44-joint disease activity score (DAS44) calculations, measurements of erythrocyte sedimentation rate, and C-reactive protein levels were performed in 68 RA patients at baseline and after 1, 3, 6, 9, and 12 months. Metacarpophalangeal joints, wrist, elbow, knee, ankle, metatarsophalangeal joints, and wrist and ankle tendons were examined by GSUS and PDUS. The laboratory and clinical findings began to decrease significantly at 1 month (P < 0.05). Improvement of the ultrasonography (US) variables began at 3 months. After 6 months, all of the joint synovitis scores, except those of the knee, elbow, and ankle joints, showed a statistically significant reduction compared to baseline scores (P < 0.001). DAS44 scores were lower in the very early RA group at 12 months compared to those whose symptom duration was greater than 3 months of RA (respectively, 1.53 ± 0.34; 1.80 ± 0.38; z = −2501, P = 0.012). The total modified Sharp scores at 12 months correlated with total PDUS synovitis scores at 12 months (r = 0.354, P = 0.003). Regression of US synovitis at large joints such as the knee, elbow, and ankle tended to be delayed compared to that at small joints. PD synovitis that is persistent despite disease-modifying anti-rheumatic drug therapy may cause radiographic bone erosions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Montecucco C (2006) Remission, a therapeutic goal in inflammatory arthropathies? Clinical data from adalimumab studies. Drugs 66:1783–1795

    Article  CAS  PubMed  Google Scholar 

  2. Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A (2005) Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 64:375–381

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Brown AK (2009) Using ultrasonography to facilitate best practice in diagnosis and management of RA. Nat Rev Rheumatol 5(12):698–706

    Article  PubMed  Google Scholar 

  4. Naredo E, Collado P, Cruz A, Palop MJ, Cabero F, Richi P (2007) Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. Arthritis Rheum 57:116–124

    Article  PubMed  Google Scholar 

  5. Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, Sattler H, Albrecht K, Kaufmann J, Becker K, Sörensen H, Meier L, Burmester GR, Schmidt WA (2009) Evaluation of a novel 7 joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 61(9):1194–1201

    Article  CAS  PubMed  Google Scholar 

  6. Neogi T, Aletaha D, Silman AJ, Naden RL, Felson DT, Aggarwal R, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Khanna D, Kvien TK, Laing T, Liao K, Mease P, Ménard HA, Moreland LW, Nair R, Pincus T, Ringold S, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G, American College of Rheumatology, European League Against Rheumatism (2010) The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: phase 2 methodological report. Arthritis Rheum 62:2582–2591

    Article  PubMed Central  PubMed  Google Scholar 

  7. Prevoo ML, van Gestel AM, van T Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL (1996) Remission in prospective study of patients with rheumatoid arthritis, American Rheumatism Association preliminary remission criteria in relation to the disease activity score. Br J Rheumatol 35(11):1101–1105

    Article  CAS  PubMed  Google Scholar 

  8. Tijhuis GJ, de Jong Z, Zwinderman AH, Zuijderduin WM, Jansen LM, Hazes JM, Vliet Vlieland TP (2001) The validity of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire. Rheumatology (Oxford) 40(10):1112–1119

    Article  CAS  Google Scholar 

  9. Witt M, Mueller F, Nigg A, Reindl C, Leipe J, Proft F, Stein N, Hammitzsch A, Mayer S, Dechant C, Schulze-Koops H, Grunke M (2013) Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis. Arthritis Rheum 65:1694–1701

    Article  PubMed  Google Scholar 

  10. Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M (2001) Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 44:2018–2023

    Article  CAS  PubMed  Google Scholar 

  11. Naredo E, D’Agostino MA, Wakefield RJ, Möller I, Balint PV, Filippucci E, Iagnocco A, Karim Z, Terslev L, Bong DA, Garrido J, Martínez-Hernández D, Bruyn GA, OMERACT Ultrasound Task Force (2013) Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 72:1328–1334

    Article  PubMed  Google Scholar 

  12. Sokka T (2008) Radiographic scoring in rheumatoid arthritis: a short introduction to the methods. Bull NYU Hosp Jt Dis 66(2):166–168

    PubMed  Google Scholar 

  13. Kamishima T, Sagawa A, Tanimura K, Shimizu M, Matsuhashi M, Shinohara M, Hagiwara H, Henmi M, Narita A, Terae S, Shirato H (2010) Semi-quantitative analysis of rheumatoid finger joint synovitis using power Doppler ultrasonography: when to perform follow-up study after treatment consisting mainly of antitumor necrosis factor alpha agent. Skeletal Radiol 39(5):457–465

    Article  PubMed  Google Scholar 

  14. Iagnocco A, Filippucci E, Perella C, Ceccarelli F, Cassarà E, Alessandri C, Sabatini E, Grassi W, Valesini G (2008) Clinical and ultrasonographic monitoring of response to adalimumab treatment in rheumatoid arthritis. J Rheumatol 35:35–40.10

    PubMed  Google Scholar 

  15. Naredo E, Möller I, Cruz A, Carmona L, Garrido J (2008) Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Arthritis Rheum 58:2248–2256

    Article  PubMed  Google Scholar 

  16. Hartung W, Kellner H, Strunk J, Sattler H, Schmidt WA, Ehrenstein B, Fleck M, Backhaus M (2012) Development and evaluation of novel ultrasound score for large joints in rheumatoid arthritis: one year of experience in daily clinical practice. Arthritis Care Res (Hoboken) 64(5):675–682

    Article  Google Scholar 

  17. Backhaus TM, Ohrndorf S, Kellner H, Strunk J, Hartung W, Sattler H, Iking-Konert C, Burmester GR, Schmidt WA, Backhaus M (2013) The US7 score is sensitive to change in large cohort of patients with rheumatoid arthritis over 12 months of therapy. Ann Rheum Dis 72(7):1163–1169

    Article  PubMed Central  PubMed  Google Scholar 

  18. Kanazawa T, Nishino J, Tohma S, Tanaka S (2013) Analysis of the affected joints in rheumatoid arthritis patients in large Japanese cohort. Mod Rheumatol 23(1):44–49

    Article  CAS  PubMed  Google Scholar 

  19. Tian J, Chen J, Li F, Xie X, Du J, Mao N, Gao J (2013) Grey scale and power Doppler ultrasonographic assessment of bone erosion and disease activity in early rheumatoid arthritis. Zhong Nan Da Xue Xue Bao Yi Xue Ban 38(12):1270–1274

    CAS  PubMed  Google Scholar 

  20. Funck-Brentano T, Gandjbakhch F, Etchepare F, Jousse-Joulin S, Miquel A, Cyteval C, Lukas C, Tobón GJ, Saraux A, Boumier P, Goupille P, Bourgeois P, Fautrel B (2013) Prediction of radiographic damage in early arthritis by sonographic erosions and power Doppler signal: a longitudinal observational study. Arthritis Care Res (Hoboken) 65(6):896–902

    Article  Google Scholar 

Download references

Acknowledgments

We thank the following physiatrist for inclusion and follow-up of their patients: Nedim Kaban, Ekrem Süleyman, and Mustafa Serdar Sağ.

Disclosure

None.

Authors’ contributions

All authors contributed to acquisition, analysis, and interpretation of the data and drafting of the manuscript.

Ethics approval

The study protocol was approved by Sakarya University local ethics committee.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Rheumatology, Faculty of Medicine, Sakarya University, Sakarya, Turkey

    Halil Harman, İbrahim Tekeoğlu & Ayhan Kamanlı

  2. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Sakarya University, Sakarya, Turkey

    Sibel Takçı & Kemal Nas

  3. Department of Radiology, Sakarya Training and Research Hospital, Sakarya, Turkey

    Sibel Harman

Authors
  1. Halil Harman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. İbrahim Tekeoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sibel Takçı
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ayhan Kamanlı
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kemal Nas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sibel Harman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Halil Harman.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harman, H., Tekeoğlu, İ., Takçı, S. et al. Improvement of large-joint ultrasonographic synovitis is delayed in patients with newly diagnosed rheumatoid arthritis: results of a 12-month clinical and ultrasonographic follow-up study of a local cohort. Clin Rheumatol 34, 1367–1374 (2015). https://doi.org/10.1007/s10067-015-2926-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-015-2926-x

Keywords

Search

Navigation