Use of ultrasound in treatment decisions for patients with rheumatoid arthritis: an observational study in Italy.
In rheumatoid arthritis (RA), treatment response is generally assessed using standard clinical disease activity measures. However, ultrasound has become increasingly popular among rheumatologists to monitor disease activity and response. The purpose of this analysis of ECOgraphic evaluation for STaging ARthritis (ECOSTAR) study data was to determine how ultrasound affects clinicians' decisions about changing treatment in RA. ECOSTAR was an observational, cohort study conducted between March 2010 and December 2012 at nine clinical centers in Italy in RA patients being considered for treatment change. After clinical evaluation of each patient, patients underwent diagnostic ultrasound (US) investigations and each patient was given a total echography score using a combination of scores for joint effusion, synovial hypertrophy, and power Doppler. The US results were provided to the clinicians and the influence of US on the clinicians' treatment choices were recorded. Ninety-five patients screened for study inclusion had confirmed RA (mean age 53.9 years; mean disease duration 8.9 years). Therapy changes were made by clinicians according to the hand and wrist joint US scores: score 0 appeared to have no influence on clinicians' decision to modify treatment, scores >0-3 were associated with a numerically higher estimated probability of not changing therapy than changing therapy, and scores >3 had a greater influence on the clinician to modify therapy and an increased probability of the clinician changing therapy versus not changing therapy. Ultrasonography scores appear to influence treatment decisions in patients with RA, with clinicians appearing less likely to alter treatment regimens in patients with low ultrasound scores and more likely to change treatment regimens when higher scores are obtained. Further research is warranted.
Rheumatology Unit, A.O. Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. oscar.epis@ospedaleniguarda.it.
Oscar
O
Epis
Sezione di Reumatologia, Dip. Interdisciplinare di Medicina, Università degli Studi 'Aldo Moro', Piazza Giulio Cesare 11, 70124, Bari, Italy.
Crescenzio
C
Scioscia
U.O. Reumatologia, ASL3-Azienda Sanitaria Genovese, Via Giappone 3, 16011, Arenzano Genova, Italy.
Antonia
A
Locaputo
SSD di Reumatologia, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, 21100, Varese, Italy.
Antonella
A
Cappelli
Struttura semplice di Reumatologia, Ospedale di Bolzano, Via L. Boehler 5, 39100, Bolzano, Italy.
Armin
A
Maier
SSD Reumatologia A.S.O. "SS Antonio e Biagio", Via Venezia 16, 15100, Alessandria, Italy.
Pier Andrea
PA
Rocchetta
Clinica Medica, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Strada di Fiume 449, 34149, Trieste, Italy.
Paola
P
Tomietto
Medicina Interna e Post Acuzie Sacile, Azienda Ospedaliera Santa Maria degli Angeli di Pordenone, via Montereale 24, 33170, Pordenone, Italy.
Antonella
A
Perin
UO di Reumatologia Ospedale SS Giovanni e Paolo, Sst. Castello, 6777, Venezia, Italy.
Chiara
C
Rigon
Servizio di Reumatologia, ASL BT - DSS 4, Piazza P. Umberto I 1, Barletta, Italy.
Leonardo
L
Santo
U.O. di Reumatologia, ASL Lecce - Polo Riabilitativo "V.Fazzi", via Croce di Lecce - San Cesario di Lecce, Lecce, Italy.
Oriana
O
Casilli
Sezione di Reumatologia, Dip. Interdisciplinare di Medicina, Università degli Studi 'Aldo Moro', Piazza Giulio Cesare 11, 70124, Bari, Italy.
Giovanni
G
Lapadula
Rheumatology Unit, A.O. Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Eleonora
E
Bruschi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000000981:diagnostic imaging; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D013256:Steroids
Clinicians’ choice of therapy; Power Doppler; Rheumatoid arthritis; Synovial hypertrophy; Ultrasound