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Joint damage in rheumatoid arthritis: Lessons learned from an extended 36‐joint ultrasonography and 28‐joint Disease Activity Score assessments
Author(s) -
Tan York Kiat,
Li HuiHua,
Allen John Carson,
Thumboo Julian
Publication year - 2021
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.14013
Subject(s) - medicine , rheumatoid arthritis , ultrasound , arthritis , joint disease , gastroenterology , pathology , radiology , osteoarthritis , alternative medicine
Aim To study joint damage severity in rheumatoid arthritis (RA) patients classified using ultrasound power Doppler (PD) and gray‐scale (GS) joint inflammation outcomes and the 28‐joint Disease Activity Score (DAS28). Method Ultrasound erosion scores were compared between (a) patients in group 1 (PD positive and GS ≥ median score), group 2 (PD negative and GS ≥ median score) and group 3 (PD positive and GS < median score) vs group 4 (PD negative and GS < median score) and (b) patients with high, moderate and low DAS28 scores vs those in DAS28 remission. Comparative analyses were performed using the 2‐sample Student's t test. Results There were 1080 joints and 1800 joint recesses from 36 joints scanned in 30 RA adult patients (mean DAS28, 3.58; mean disease duration, 70.3 months) in this cross‐sectional study. The mean and 95% CI ultrasound erosion scores were significantly higher ( P = .026) for groups 1 (9.75, 6.69‐12.81) vs 4 (3.4, 1.11‐5.69) with a difference (95% CI) of 6.35 (0.78‐11.83), but not significantly different ( P values all > .05) for (a) groups 2 and 3 vs 4 and (b) patients with high, moderate and low DAS28 scores vs those in DAS28 remission. Conclusion Severity of ultrasound‐detected bone erosions was significantly greater when both positive PD and a greater degree of GS joint inflammation were present in RA. This association was not observed when either component was absent. Single time point ultrasound joint inflammation assessment – and not DAS28 – is reflective of joint damage severity in RA patients.