Higher Baseline and Grayscale Ultrasound Synovitis not tied with Worse RA Prognosis: Study

They retrospectively analyzed 138 patients with RA. Patients' first MSUS record was considered as the baseline expression. The subsequent MSUS changes that showed alleviation or progression were regarded as the cutoff point. Grayscale ultrasound (GSUS) synovitis, power Doppler ultrasound (PDUS) synovitis, PDUS tenosynovitis (TS), and bone erosion were scored using a semi-quantitative scale. According to the ultrasound (US) results of the cutoff point, patients were divided into the alleviation group and the progression group. Laboratory results (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], rheumatoid factor [RF], anti-cyclic citrullinated peptide [anti-CCP] antibody, and anti-keratin antibody [AKA]), disease activity score in 28 joints (DAS28)-ESR, and US scores were compared between the two groups to analyze the prognostic value of US findings in RA.journals.lww.com

Results:

The alleviation group had higher levels of CRP, synovitis, TS, GSUS synovitis, PDUS synovitis, PDUS TS, and US total scores at baseline than the progression group (p < 0.05). The alleviation group received more aggressive treatment in their initial approach than the progression group (p < 0.05). The frequency of US examinations in the alleviation group was more than that in the progression group at follow-up (p < 0.05). Presence of baseline synovitis (OR 0.248, p = 0.006) and a higher GSUS synovitis score (OR 0.521, p = 0.006) were negatively correlated with RA progression.

Thus, the presence of baseline synovitis and higher GSUS synovitis score does not always indicate a worse prognosis of RA, which can be improved with aggressive treatment. Regular MSUS follow-up may have positive influences on prognosis.

Reference:

Sun C, Qi X, Yang Y, Lei L, Gao L, Guo H. Importance of baseline musculoskeletal ultrasound findings in the prognosis of rheumatoid arthritis [published online ahead of print, 2022 Jan 18] [published correction appears in Clin Rheumatol. 2022 Jan 28;:]. Clin Rheumatol. 2022;10.1007/s10067-021-06017-7. doi:10.1007/s10067-021-06017-7Journal of Clinical Rheumatology