ABSTRACT
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Subject(s)
Humans , Female , Adult , Middle Aged , Immunoglobulin G4-Related Disease/diagnostic imaging , Immunoglobulin G4-Related Disease/drug therapy , Immunoglobulin G4-Related Disease/blood , Immunoglobulin G4-Related Disease/physiopathology , Adrenal Cortex Hormones , Prednisone , AzathioprineSubject(s)
Immunoglobulin G4-Related Disease/diagnosis , Abdominal Pain/etiology , Adult , Colonic Diseases/etiology , Colonic Diseases/surgery , Female , Granuloma, Plasma Cell/etiology , Granuloma, Plasma Cell/surgery , Humans , Immunoglobulin G4-Related Disease/complications , Immunoglobulin G4-Related Disease/diagnostic imaging , Immunoglobulin G4-Related Disease/drug therapy , Immunosuppressive Agents/therapeutic use , Middle Aged , Plasma Cells/pathology , Pleural Effusion/drug therapy , Pleural Effusion/etiology , Recurrence , Thyroiditis, Autoimmune/complicationsABSTRACT
OBJECTIVE: To investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44-joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent. METHODS: A total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated. RESULTS: A PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44-joint count and index for synovitis and PD signal and the 12-joint count and index for synovitis and PD signal at baseline and 6 months (r = 0.84-0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables. CONCLUSION: A 12-joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.