Tan, YK, Chew, L-C, Allen, JC et al. (5 more authors) (2018) Utility of ultrasonography in guiding modification of disease modifying anti‐rheumatic drugs and steroid therapy for inflammatory arthritis in routine clinical practice. International Journal of Rheumatic Diseases, 21 (1). pp. 155-160. ISSN 1756-1841
Abstract
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 DMARDs 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 DMARDs, 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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd. This is the peer reviewed version of the following article: Tan, Y. K., Chew, L. , Allen, J. C., Lye, W. K., Htay, L. L., Hassan, A. , Conaghan, P. G. and Thumboo, J. (2018), Utility of ultrasonography in guiding modification of disease modifying anti‐rheumatic drugs and steroid therapy for inflammatory arthritis in routine clinical practice. Int J Rheum Dis, 21: 155-160., which has been published in final form at https://doi.org/10.1111/1756-185X.12933. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | inflammatory arthritis; rheumatoid arthritis; synovitis; ultrasound |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 10 Jun 2016 11:00 |
Last Modified: | 19 Mar 2018 09:25 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/1756-185X.12933 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:100720 |