Drs. Reiche and Ohrndorf contributed equally to this work.
Usefulness of Power Doppler Ultrasound for Prediction of Re-Therapy With Rituximab in Rheumatoid Arthritis: A Prospective Study of Longstanding Rheumatoid Arthritis Patients
Article first published online: 28 JAN 2014
Copyright © 2014 by the American College of Rheumatology
Arthritis Care & Research
Volume 66, Issue 2, pages 204–216, February 2014
How to Cite
Reiche, B. E., Ohrndorf, S., Feist, E., Messerschmidt, J., Burmester, G. R. and Backhaus, M. (2014), Usefulness of Power Doppler Ultrasound for Prediction of Re-Therapy With Rituximab in Rheumatoid Arthritis: A Prospective Study of Longstanding Rheumatoid Arthritis Patients. Arthritis Care Res, 66: 204–216. doi: 10.1002/acr.22103
- Issue published online: 28 JAN 2014
- Article first published online: 28 JAN 2014
- Accepted manuscript online: 7 AUG 2013 01:23PM EST
- Manuscript Accepted: 30 JUL 2013
- Manuscript Received: 7 NOV 2012
- Roche Pharma AG Grenzach-Wyhlen, Germany
To assess the value of gray-scale (GS) and power Doppler (PD) ultrasound (US) in detecting inflammatory/destructive changes and for prediction of necessity of re-therapy with rituximab (RTX) in patients with rheumatoid arthritis (RA) over 1 year of followup.
GSUS and PDUS were performed to assess synovitis, tenosynovitis, and erosions on the clinically dominant hand and forefoot of 20 patients with RA before and after therapy with RTX. US parameters were compared with clinical (Disease Activity Score in 28 joints, tender/swollen joint counts, and patients' visual analog scale of disease activity) and laboratory parameters (C-reactive protein level and erythrocyte sedimentation rate). Results were compared for patients with and without re-therapy with RTX.
Significant decreases in clinical and laboratory parameters were observed after 6 and 12 months. US synovitis scores significantly decreased after 6 and 12 months (P < 0.05 for each). Regarding patients who received re-therapy between 6 and 9 months after the start of therapy (n = 9), a fair therapy response was still detectable before re-therapy. In these patients, PD-positive synovitis was the only parameter that increased up to the 6-month examination. All patients negative for rheumatoid factor and anti–cyclic citrullinated peptide (n = 4) were in the group of patients receiving a second course of treatment. Seropositive patients showed a better response to treatment with less need for re-therapy.
Response to therapy was measurable by clinical and laboratory parameters as well as by US. Since PDUS was able to detect the onset of disease activity before worsening of clinical symptoms occurred, PDUS is most helpful in evaluating disease activity and making earlier therapy decisions.