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Utility of ultrasonography in guiding modification of disease modifying anti‐rheumatic drugs and steroid therapy for inflammatory arthritis in routine clinical practice
Author(s) -
Tan York Kiat,
Chew LiChing,
Allen John C,
Lye Weng Kit,
Htay Lei Lei,
Hassan Ali,
Conaghan Philip G,
Thumboo Julian
Publication year - 2018
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12933
Subject(s) - medicine , erythrocyte sedimentation rate , rheumatoid arthritis , psoriatic arthritis , arthritis , rheumatology , gastroenterology
Objective To determine the utility of ultrasonography in guiding modification of disease‐modifying anti‐rheumatic drug ( DMARD ) and steroid therapy for inflammatory arthritis ( IA ) in routine clinical practice. Methods In this retrospective study, we analyzed DMARD and steroid use in IA patients referred to a rheumatologist‐led ultrasound clinic. Power Doppler ( PD ) vascularity and greyscale ( GS ) synovial hypertrophy joint findings were categorized as positive/negative for each patient. The erythrocyte sedimentation rate ( ESR ) was used as a measure of disease activity. Results We assessed single visit data for 46 adult IA patients: 67.4% ( n = 31) rheumatoid arthritis ( RA ), 15.2% ( n = 7) psoriatic arthritis, 10.9% ( n = 5) spondyloarthritis, and 6.5% ( n = 3) undifferentiated IA . The mean ESR was 28.8 mm/h. Thirty‐seven patients with both GS and PD ultrasound results were subsequently analyzed. All patients ( n = 10) escalated and/or initiated on DMARD and 9/10 patients escalated or initiated on steroids were PD and GS positive. Six of seven patients with dose reduction and/or cessation of DMARD s and five of seven patients with dose reduction or cessation of steroids were PD negative. Of six patients who were GS positive and PD negative, three had dose reduction and/or cessation of DMARD s, while four had dose reduction of steroids; none of the six patients had DMARD /steroid escalation. Conclusion By clarifying joint inflammation in an IA cohort with overall low ESR , ultrasonography of physician‐selected joints can improve clinical assessment, resulting in treatment modification. Positive PD findings were particularly influential, while the clinical significance of GS positivity alone requires further investigation.