title: After treat-to-target: can a targeted ultrasound initiative improve RA outcomes?
abstract: For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network--the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA.
authors.affiliation: Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine LIMM, University of Leeds, Leeds, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: D'Agostino
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.forename: Maya H
authors.initials: MH
authors.lastname: Buch
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.forename: Lene
authors.initials: L
authors.lastname: Terslev
authors.forename: Mikkel
authors.initials: M
authors.lastname: Ostergaard
authors.forename: Marina
authors.initials: M
authors.lastname: Backhaus
authors.forename: Walter
authors.initials: W
authors.lastname: Grassi
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Gerd R
authors.initials: GR
authors.lastname: Burmester
authors.forename: Benazir
authors.initials: B
authors.lastname: Saleem
authors.forename: Eugenio
authors.initials: E
authors.lastname: de Miguel
authors.forename: Cristina
authors.initials: C
authors.lastname: Estrach
authors.forename: Kei
authors.initials: K
authors.lastname: Ikeda
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
authors.forename: Robert
authors.initials: R
authors.lastname: Thompson
authors.forename: Peter
authors.initials: P
authors.lastname: Balint
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D012074:Remission Induction; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000276:immunology; D014463:Ultrasonography
chemical_list: D018501:Antirheumatic Agents