Predicting joint destruction in rheumatoid arthritis with power Doppler, anti-citrullinated peptide antibody, and joint swelling.
OBJECTIVE
To determine combined evaluation of musculoskeletal ultrasonography (MSUS) and power Doppler (PD) signals, anti-citrullinated peptide antibody (ACPA), and other clinical findings improve the prediction of joint destruction in rheumatoid arthritis (RA).


METHODS
We performed a retrospective study of 331 RA patients (female n = 280 and male n = 51, mean age: 57.9 ± 13.2 years) who underwent MSUS from 2002 to 2012. Correlations with progression of joint destructions in 1,308 2nd and 3rd metacarpophalangeal (MCP) joints and various factors including PD signals of the same joints, clinical findings, age, disease duration at the study entry, gender, observation period, radiographic bone scores according to modified Sharp-van der Heijde methods, ACPA, and rheumatoid factor (RF) were analyzed in patient- and joint-based fashions, using univariate and multivariate logistic regression analyses and generalized linear mixed model.


RESULTS
Patients' characteristics were as follows: mean disease duration: 5.7 ± 7.5 years, observation period: 4.6 ± 2.6 years, RF positivity: 79.9%, and ACPA positivity: 77.5%. PD-positive 2nd and 3rd joints showed higher rate of joint destruction, especially in ACPA-positive patients. Moreover, PD-positive joints in ACPA-positive patients showed joint destruction even in joints without swelling. Multivariate analysis determined PD, swollen joint (SJ), observation period, basal radiographic bone scores, and ACPA as independent risks for joint destruction.


CONCLUSIONS
PD, SJ, basal radiographic bone scores, and ACPA are independent predictors for the joint destruction of 2nd and 3rd MCPs in RA; thus, considering these factors would be useful in daily practice.
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Yohei
Y
Kirino
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Maasa
M
Hama
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Kaoru
K
Takase-Minegishi
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Yosuke
Y
Kunishita
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Daiga
D
Kishimoto
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Ryusuke
R
Yoshimi
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Yukiko
Y
Asami
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.|b Department of Rheumatology and Infectious disease , Minami Kyosai Hospital, Yokohama Minami Kyosai Hospital , Yokohama, Kanagawa , Japan.
Atsushi
A
Ihata
c Department of Biostatistics and Epidemiology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Mari S
MS
Oba
d Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya, Hyogo , Japan.
Shinichiro
S
Tsunoda
e Center for Rheumatic diseases, Yokohama City University Medical Center , Yokohama, Kanagawa , Japan.
Shigeru
S
Ohno
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Atsuhisa
A
Ueda
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Mitsuhiro
M
Takeno
a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama, Kanagawa , Japan.
Yoshiaki
Y
Ishigatsubo
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D012189:Retrospective Studies; D012217:Rheumatoid Factor; D012307:Risk Factors; D014463:Ultrasonography
D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor
Power Doppler; Prediction; Ultrasound