title: Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial.
abstract: OBJECTIVE
  To investigate whether an intensive early rheumatoid arthritis (RA) treat-to-target (T2T) strategy could be improved through the use of musculoskeletal ultrasound (MSUS) assessment of disease activity.
  
  
  METHODS
  111 newly diagnosed patients with RA or undifferentiated arthritis (symptom duration <1 year) were randomised to strategies that aimed to attain either DAS28-erythrocyte sedimentation rate (ESR)<3.2 (control) or a total power Doppler joint count≤1 during a combined DAS28-ESR/MSUS assessment (intervention). MSUS examination was indicated if: DAS28-ESR<3.2 or DAS28-ESR≥3.2 with two swollen joints. Step-up disease-modifying antirheumatic drug (DMARD) escalation was standardised: methotrexate monotherapy, triple therapy and then etanercept/triple therapy. American College of Rheumatology (ACR) core-set variables were assessed 3 monthly by a metrologist blinded to group allocation. MRI of dominant hand and wrist, and plain radiographs of hands and feet were undertaken at baseline and 18 months for grading by two readers using the Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis MRI Scoring System (RAMRIS) and van der Heijde/Sharp Score, respectively. The coprimary outcomes were mean change from baseline of DAS44 and RAMRIS erosion score.
  
  
  RESULTS
  Groups were matched for baseline clinical, demographic and radiographic features. The intervention group received more intensive DMARD therapy. Both groups demonstrated significant improvements in DAS44 (mean change: control -2.58, intervention -2.69; 95% CI difference between groups -0.70 to 0.48; p=0.72). There were no significant between-group differences for any ACR core-set variables, except DAS44 remission after 18 months (control 43%, intervention 66%; p=0.03). There was minimal progression of MRI and radiographic erosions and no difference in imaging outcomes or serious adverse event rates.
  
  
  CONCLUSIONS
  In early RA, a MSUS-driven T2T strategy led to more intensive treatment, but was not associated with significantly better clinical or imaging outcomes than a DAS28-driven strategy.
  
  
  BACKGROUND
  NCT00920478.
authors.affiliation: Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK Department of Rheumatology, Wishaw General Hospital, Glasgow, UK.
authors.forename: James
authors.initials: J
authors.lastname: Dale
authors.affiliation: Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Stirling
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
authors.forename: Ruiqi
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Management Science, Strathclyde University, Glasgow, UK.
authors.forename: David
authors.initials: D
authors.lastname: Purves
authors.affiliation: Department of Radiology, Edinburgh Royal Infirmary, Edinburgh, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Foley
authors.affiliation: Department of Radiology, East Sussex Hospitals Trust, Eastbourne, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Sambrook
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Conaghan
authors.affiliation: Department of Rheumatology, Leiden University Medical Centre, Leiden, UK.
authors.forename: Désirée
authors.identifier: http://orcid.org/0000-0002-5781-158X
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
authors.forename: Iain B
authors.initials: IB
authors.lastname: McInnes
authors.affiliation: Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: Porter
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D001799:Blood Sedimentation / Q000187:drug effects; D018450:Disease Progression; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000008:administration & dosage; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D011859:Radiography / Q000379:methods; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*; D014953:Wrist / Q000000981:diagnostic imaging
chemical_list: D018501:Antirheumatic Agents; D000068800:Etanercept; D008727:Methotrexate
keywords: DAS28; Early Rheumatoid Arthritis; Ultrasonography