title: Utility of ultrasonography in guiding modification of disease modifying anti-rheumatic drugs and steroid therapy for inflammatory arthritis in routine clinical practice.
abstract: OBJECTIVE
  To determine the utility of ultrasonography in guiding modification of disease-modifying anti-rheumatic drug (DMARD) and steroid therapy for inflammatory arthritis (IA) in routine clinical practice.
  
  
  METHODS
  In this retrospective study, we analyzed DMARD and steroid use in IA patients referred to a rheumatologist-led ultrasound clinic. Power Doppler (PD) vascularity and greyscale (GS) synovial hypertrophy joint findings were categorized as positive/negative for each patient. The erythrocyte sedimentation rate (ESR) was used as a measure of disease activity.
  
  
  RESULTS
  We assessed single visit data for 46 adult IA patients: 67.4% (n = 31) rheumatoid arthritis (RA), 15.2% (n = 7) psoriatic arthritis, 10.9% (n = 5) spondyloarthritis, and 6.5% (n = 3) undifferentiated IA. The mean ESR was 28.8 mm/h. Thirty-seven patients with both GS and PD ultrasound results were subsequently analyzed. All patients (n = 10) escalated and/or initiated on DMARD and 9/10 patients escalated or initiated on steroids were PD and GS positive. Six of seven patients with dose reduction and/or cessation of DMARDs and five of seven patients with dose reduction or cessation of steroids were PD negative. Of six patients who were GS positive and PD negative, three had dose reduction and/or cessation of DMARDs, while four had dose reduction of steroids; none of the six patients had DMARD/steroid escalation.
  
  
  CONCLUSIONS
  By clarifying joint inflammation in an IA cohort with overall low ESR, ultrasonography of physician-selected joints can improve clinical assessment, resulting in treatment modification. Positive PD findings were particularly influential, while the clinical significance of GS positivity alone requires further investigation.
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: York Kiat
authors.initials: YK
authors.lastname: Tan
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Chew
authors.affiliation: Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors.forename: John C
authors.initials: JC
authors.lastname: Allen
authors.affiliation: Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Weng Kit
authors.initials: WK
authors.lastname: Lye
authors.affiliation: Rheumatology Department, Yangon Specialty Hospital, Yangon, Myanmar.
authors.forename: Lei Lei
authors.initials: LL
authors.lastname: Htay
authors.affiliation: Internal Medicine, Brooks Hospital - Alberta Health Services, Brooks, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Hassan
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 and Immunology, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.|Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001168:Arthritis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D001799:Blood Sedimentation; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging* / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D018501:Antirheumatic Agents; D013256:Steroids
keywords: inflammatory arthritis; rheumatoid arthritis; synovitis; ultrasound