title: Radiographic prognosis of finger joint damage predicted by early alteration in synovial vascularity in patients with rheumatoid arthritis: Potential utility of power doppler sonography in clinical practice.
abstract: OBJECTIVE
  To investigate the relationship between synovial vascularity and progression of structural bone damage in each finger joint in patients with rheumatoid arthritis (RA) and to demonstrate synovial vascularity as a potential therapeutic marker.
  
  
  METHODS
  We studied 250 metacarpophalangeal (MCP) and 250 proximal interphalangeal (PIP) joints of 25 patients with active RA who were administered adalimumab or tocilizumab. Patients were examined with clinical and laboratory assessments. Power Doppler sonography was performed at baseline and at the fourth and eighth weeks. Synovial vascularity was evaluated according to quantitative measurement. Hand and foot radiography was performed at baseline and the twentieth week.
  
  
  RESULTS
  Clinical indices such as the 28-joint Disease Activity Score, the Clinical Disease Activity Index, and the Simplified Disease Activity Index were significantly decreased by biologic agents. The MCP and PIP joints with no response in synovial vascularity between baseline and the eighth week (vascularity improvement of ≤70% at the eighth week) showed a higher risk of radiographic progression compared with responsive joints (vascularity improvement of >70% at the eighth week; relative risk 2.33-9). Radiographic progression at the twentieth week was significantly lower in responsive joints than in nonresponsive joints.
  
  
  CONCLUSIONS
  The improvement of synovial vascularity following treatment with biologic agents led to suppression of radiographic progression of RA in each finger joint. The alteration in synovial vascularity numerically reflected therapeutic efficacy. Using vascularity as a marker to determine the most suitable therapeutic approach would be beneficial for patients with active RA.
authors.affiliation: Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan. jun.fukae@ryumachi-jp.com
authors.forename: Jun
authors.initials: J
authors.lastname: Fukae
authors.forename: Masato
authors.initials: M
authors.lastname: Isobe
authors.forename: Akemi
authors.initials: A
authors.lastname: Kitano
authors.forename: Mihoko
authors.initials: M
authors.lastname: Henmi
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Sakamoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Narita
authors.forename: Takeya
authors.initials: T
authors.lastname: Ito
authors.forename: Akio
authors.initials: A
authors.lastname: Mitsuzaki
authors.forename: Masato
authors.initials: M
authors.lastname: Shimizu
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Tanimura
authors.forename: Megumi
authors.initials: M
authors.lastname: Matsuhashi
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kamishima
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Atsumi
authors.forename: Takao
authors.initials: T
authors.lastname: Koike
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging* / Q000187:drug effects; D006801:Humans; D007564:Japan; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging* / Q000187:drug effects; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011859:Radiography; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000098:blood supply* / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D018617:Ultrasonography, Doppler, Pulsed
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000068879:Adalimumab; C502936:tocilizumab