Musculoskeletal Ultrasound Assessment Changes Management Decisions in Rheumatoid Arthritis Patients With Moderate Disease Activity

Background

Musculoskeletal ultrasound (MSUS) provides valuable information about disease activity and anatomical damage in rheumatoid arthritis (RA); therefore, in combination with clinical assessment, it may be a useful tool in clinical decision-making with treatment.

Objectives

(1) To evaluate the impact of MSUS assessment on treatment decisions in patients with moderately active RA receiving conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). (2) To determine the level of concordance between MSUS assessment and DAS28 in these patients.

Methods

RA patients with a DAS-28 ranging from 3.22–5.1, inadequate response to csDMARDs, and indication for escalating treatment were enrolled. All patients underwent an ultrasound (US) examination (B and PD modes) of the bilateral 5-joint count (5USJC), the symptomatic joints of the DAS-28 score (28USJC), and of a comprehensive 78-joint count (78USJC). A Likert scale (pre- and post-MSUS) was used to assess patients' and clinicians' desires to escalate treatment. The outcome of the treatment decision based on US assessment was reviewed at 24 months' follow-up.

Results

Among the 27 patients included, the mean (SD) DAS-28 score was 4.4 (0.7). Following US assessment, there was a change in the decision to escalate treatment in 18 patients (66.7%), and at a median follow-up of 24 months, only in 5 of the 18 patients had the treatment had been escalated. Treatment escalation was associated with a higher US score across all assessments (5USJC, 28USJC, 78USJC) (p < 0.05). The 78USJC was the most reliably aligned with the treatment decision (p = 0.009). A comparison of the US and clinical assessment revealed poor concordance between all variables of the DAS-28 and US scores, except for the swollen joint count.

Conclusion

The addition of MSUS assessment to the DAS-28 score affected management decisions in 66.7% of patients.