title: Very early improvements in the wrist and hand assessed by power Doppler sonography predicting later favorable responses in tocilizumab-treated patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the response of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) by ultrasonographic evaluation of changes in the wrist and hand, and to determine whether such assessments during early TCZ treatment predict later clinical outcome.
  
  
  METHODS
  Thirty-two RA patients about to receive TCZ treatment were examined by ultrasound at baseline and after 2 weeks using the Outcome Measures in Rheumatology Clinical Trials semiquantitative scoring of 22 joints (both wrists, proximal interphalangeal joints 1-5, and metacarpophalangeal joints 1-5) as well as clinical and laboratory variables, leading to a calculation of composite indexes. The aim was to determine whether methotrexate treatment and clinical, laboratory, and ultrasonographic evaluation after 2 weeks of TCZ treatment predict treatment outcome at 24 weeks, as assessed by the Disease Activity Score in 28 joints (DAS28).
  
  
  RESULTS
  Changes of ultrasound scores after 2 weeks were found to be correlated with changes in DAS28 at 24 weeks (r = 0.545-0.622, P < 0.05). The change of sum power Doppler scores after 2 weeks of treatment was identified as the variable most closely correlated with the change in DAS28 at 24 weeks (r = 0.622, P < 0.05).
  
  
  CONCLUSIONS
  The best predictors after 2 weeks of favorable treatment outcome at 24 weeks were improved power Doppler scores. Methotrexate treatment and composite indexes did not predict favorable treatment outcome in this study.
authors.affiliation: Hiroshima Clinic, Hiroshima, Japan. kumekensuke@live.jp
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kume
authors.forename: Kanzo
authors.initials: K
authors.lastname: Amano
authors.forename: Susumu
authors.initials: S
authors.lastname: Yamada
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hatta
authors.forename: Noriko
authors.initials: N
authors.lastname: Kuwaba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohta
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004185:Disability Evaluation; 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*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000187:drug effects*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C502936:tocilizumab; D008727:Methotrexate