Generalized estimating equation model to compare drug effects on synovitis of the dominant wrist in severe rheumatoid arthritis between tocilizumab versus adalimumab versus abatacept using high-resolution ultrasound.

PURPOSE: The use of biological agents has revolutionized the treatment of rheumatoid arthritis (RA). However, details of serial synovial changes in imaging evaluation are unclear. Using power Doppler (PD) ultrasound, this study aimed to evaluate the comparative efficacy of biologicals for patients with refractory RA, with the hope that these findings could aid in clinical decision making. METHODS: Patients with RA who received abatacept, adalimumab or tocilizumab therapy were enrolled. All underwent gray scale synovial hypertrophy and PD assessments of the dominant wrist (dorsal aspect) at baseline and at 1, 3 and 6 months after therapy. A generalized estimating equation model was used to compare efficacy among the three drugs. RESULTS: Of the 103 patients enrolled, 32 received adalimumab, 38 abatacept and 33 tocilizumab. There were no significant differences in age or sex among the three groups. All had a treatment response according to gray scale (P = 0.000) and PD (P = 0.001) synovitis scores. The tocilizumab group had a significantly lower synovial hypertrophy score at 6 months (P = 0.006), and the adalimumab group also had a lower score although without statistical significance (P = 0.043). The adalimumab group had a lower PD score than the other two groups (P < 0.05). CONCLUSION: In a 6-month head-to-head comparison of patients with RA, tocilizumab and adalimumab had a greater effect on reducing synovial hypertrophy, while adalimumab had a greater effect in controlling inflammation in PD.

Analysis of distribution and severity of inflammation in patients with osteoarthitis compared to rheumatoid arthritis by ICG-enhanced fluorescence optical imaging and musculoskeletal ultrasound: a pilot study.

BACKGROUND: In rheumatoid arthritis (RA), hand synovitis appears especially in wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. In hand osteoarthritis (OA), potential inflammatory changes are mainly present in PIP and distal interphalangeal (DIP) joints. Joint inflammation can be visualised by fluorescence optical imaging (FOI) and musculoskeletal ultrasound (US). OBJECTIVE: Comparison of the amount and distribution of inflammatory signs in wrist and finger joints of the clinically dominant hand in patients with OA and RA by FOI and gray-scale (GSUS) and power Doppler US (PDUS). METHODS: FOI and GSUS/PDUS were performed in 1.170 joints (wrists, MCP, PIP, DIP) in 90 patients (67 RA, 23 OA). Joint inflammation was graded by a semiquantitative score (0-3) for each imaging method. RESULTS: GSUS/PDUS showed wrist and MCP joints mostly affected in RA. DIP joints were graded higher in OA. In FOI, RA and OA featured inflammatory changes in the respective joint groups depending on the phase of fluorescence dye flooding. CONCLUSIONS: US and FOI detected inflammation in both RA and OA highlighting the inflammatory component in the course of OA. The different inflammatory patterns and various shapes of fluorescence enhancement in FOI may offer opportunities to distinguish and determine the inflammatory status in both diseases.

Radiographic Structural Damage Is Worse in the Dominant than the Non-Dominant Hand in Individuals with Early Rheumatoid Arthritis.

OBJECTIVE: The relationship between mechanical stress and radiographic progression in rheumatoid arthritis (RA) is unclear. The assumption is that mechanical stress is greater in the dominant hand. Therefore, the aim of the present study was to compare the presence and progression of erosions and joint space narrowing (JSN) in the dominant and non-dominant hand. METHODS: Data from 194 patients recently diagnosed with seropositive RA, and with hand radiographs taken at the time of diagnosis and at 2-year follow-up, were analyzed retrospectively. Radiographs were scored using the van der Heijde-modified Sharp Score (HSS) method. Each joint group within each hand was rated separately by two independent examiners in a double-blinded manner. RESULTS: One hundred and ninety-four patients were enrolled (80% female, 88% positive rheumatoid factor, 92% positive anti-citrullinated protein antibody, and 95.4% right-handed). The baseline, follow-up erosion and JSN HSS were significantly higher in the dominant hand than in the non-dominant hand. The annual rate of radiographic progression was also higher in the dominant hand. The erosive progression in the wrist joints varied significantly according to handedness, but the erosion in the proximal interphalangeal joints and metacarpophalangeal joints was similar in both hands. The radiographic progression was associated with the dominant hand, an abnormal baseline C-reactive protein level, and joint damage at baseline. There was no significant difference in bone mineral density between the right and left hands. CONCLUSION: Radiological damage was worse and progressed faster in the dominant hand, suggesting that mechanical stress is associated with radiographic joint damage in early and active RA.