title: Predictor of Hand Radiological Progression in Patients With Rheumatoid Arthritis Receiving TNF Antagonist Therapy by Change in Grayscale Synovitis-A Preliminary Study.
abstract: OBJECTIVE
  This prospective study aimed to compare synovial ultrasound scores to conventional measures (DAS28, CRP levels) in predicting radiographic progression in patients with rheumatoid arthritis under TNF antagonist therapy.
  
  
  METHODS
  Patients with RA who received TNF antagonist therapy were enrolled, all of whom underwent clinical, laboratory, and ultrasonographic assessments with grayscale and power Doppler assessments of bilateral elbows (anterior and posterior recess), wrists (dorsal, palmar, and ulnar aspects), second and third MCP joints (dorsal and palmar recess), and PIP II and III (dorsal and palmar) at baseline and at 1, 3 months. Hand radiographic damage was evaluated using van der Heijde modified Total Sharp Score (TSS) at baseline and 12 months.
  
  
  RESULTS
  Thirty-two patients (384 joints, 832 synovial sites) continued the same treatment regimen for 12 months and completed the study, 41.6% of whom showed radiographic progression during the study period. Baseline DAS28 (P = 0.123), CRP level (P = 0.177), grayscale synovitis (P = 0.092), and power Doppler synovitis (P = 0.120) could not predict radiological damage in the TNF antagonist therapy group. However, ΔTSS was significantly related to changes in grayscale synovitis between baseline and 1 month (P = 0.011), but not at 3 months (P = 0.591), and was not related to changes in the power Doppler score at 1 (P = 0.634) and 3 months (P = 0.298).
  
  
  CONCLUSIONS
  Our data confirm that delayed improvement in grayscale synovitis between baseline and 1 month more accurately reflects 1-year radiological damage than conventional measures such as DAS28 score and CRP level. Therefore, we recommend serial ultrasound follow-up of patients with RA receiving TNF antagonist therapy.
authors.affiliation: From the Departments of *Rheumatology, and †Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ying-Chou
authors.initials: YC
authors.lastname: Chen
authors.forename: Fu-Mei
authors.initials: FM
authors.lastname: Su
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Hsu
authors.forename: Jia-Feng
authors.initials: JF
authors.lastname: Chen
authors.forename: Tien-Tsai
authors.initials: TT
authors.lastname: Cheng
authors.forename: Han-Ming
authors.initials: HM
authors.lastname: Lai
authors.forename: Wen-Chan
authors.initials: WC
authors.lastname: Chiu
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology; D002097:C-Reactive Protein / Q000032:analysis; D018450:Disease Progression; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography / Q000379:methods; D015203:Reproducibility of Results; D012107:Research Design; D013585:Synovitis / Q000175:diagnosis / Q000209:etiology; D013624:Taiwan; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D018608:Ultrasonography, Doppler / Q000379:methods
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000068879:Adalimumab