| Popis: |
Background Musculoskeletal Ultrasound (MSUS) has been shown to be superior to clinical examination in the detection of synovitis in patients with Rheumatoid Arthritis (RA), and can be used to improve diagnostic accuracy and potentially monitor disease changes in order to make treatment decisions aimed at optimising patient care. Since the creation of the Canadian Rheumatology Ultrasonography Society (CRUS) in 2010, an increasing number of rheumatologists has been trained in the use of MSUS. Objectives The overall study objective is to compare the effectiveness of MSUS to Routine Care (RC) as a disease management tool in patients with moderate-to-severe RA for whom a change in treatment is indicated. In addition, the predictive power of MSUS assessments has been assessed here. Methods ‘Echo’ is a prospective two-cohort, quasi-experimental study of patients diagnosed with active moderate-to-severe RA managed either with MSUS (within CRUS) or as per RC. To be eligible for the study patients must require a change in treatment as per the judgment of the treating physician. Patients are followed for 1 year with assessments at baseline, 3, 6, 9, and 12 months. Key outcome measures of interest include CDAI LDA/Remission, DAS-28 LDA/Remission, patient satisfaction (TSQM) and patient perception of participation in disease management (PAM-13). Results A total of 383 patients (71.5% female) with a mean (SD) age of 58.7 (11.7) years and disease duration of 7.0 (10.0) years were enrolled, without any significant differences between treatment groups. At baseline, a greater proportion of patients in the MSUS group were treated with a biologic DMARD (bDMARD; 50.3% vs 35.8%, p=0.004); patients in the RC group were more likely to be treated with a non-biologic DMARD (nbDMARD; 84.2% vs 91.5%, p=0.027). Over time, a comparable proportion of patients in the two groups started/switched a bDMARD (21.6% vs 15.6%, p=0.126) or added/switched a nbDMARD (18.7% vs 23.6%, p=0.248). The overall number of treatment modifications was also similar between groups (3.0 vs 2.7, p=0.236). Upon adjusting for age, gender, previous bDMARD treatment, and baseline parameter level, no differences between the two treatment groups with respect to CDAI LDA/Remission, DAS-28 LDA/Remission, and TSQM score were observed during follow-up. However, the PAM-13 score was significantly higher in the MSUS group (69.6 vs 64.2, p=0.02). In the MSUS group, higher total US erosion score at baseline was associated with a lower rate of CDAI LDA at 12 months (OR=0.86; p=0.047); higher total PD synovitis score at baseline was associated with a lower rate of CDAI LDA at 6 months (OR=0.90; p=0.010), and; higher total synovitis GREY scale at baseline was associated with lower rates of DAS28 LDA (OR=0.93; p=0.026) and DAS28 remission (OR=0.94; p=0.061) at 6 months. Conclusions MSUS assessments can be useful predictors of future disease remission in patients with RA. MSUS may be associated with increased patient perception of participation in disease management and patient activation. Acknowledgements The Sponsors of this investigator-initiated study are the Canadian Rheumatology Ultrasonography Society (CRUS) and JSS Medical Research (in-kind support). The study is supported by an unrestricted grant by AbbVie. Disclosure of Interest None declared |
