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Musculoskeletal ultrasound to complement clinical evaluation and drive treatment of rheumatoid arthritis patients in remission does not prevent worsening of patient-reported outcomes: the ULTRAPRO randomised controlled study


1, 2, 3, 4

 

  1. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Subirán, Mexico City, Mexico.
  2. Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Subirán, Mexico City, Mexico.
  3. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Subirán, Mexico City, Mexico.
  4. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Subirán, Mexico City, Mexico. virtichu@gmail.com

CER12751
2020 Vol.38, N°6
PI 1182, PF 1190
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PMID: 32242808 [PubMed]

Received: 06/09/2019
Accepted : 28/01/2020
In Press: 28/03/2020
Published: 03/12/2020

Abstract

OBJECTIVES:
The primary objective was to determine the impact of sharing musculoskeletal ultrasound (MUS) results with rheumatologists on worsening patient-reported outcomes (PROs) at 6 months of follow-up in rheumatoid arthritis (RA) patients with clinical remission. Secondary objectives were to describe MUS findings and to compare the proportion of patients with flares, according to the DAS28-ESR, following the intervention.
METHODS:
Ninety-four consecutive outpatients with clinical remission had PROs and a treatment proposal recorded at study entry. MUS was then performed by trained specialists who were blinded to clinical assessments. Forty-seven patients were randomised (1:1) to either the intervention group (MUS data shared with the primary rheumatologist) or the control group (data not shared); changes in the treatment proposal were recorded. PROs worsening and the proportion of patients with ares were compared between both groups at 6±2 months of follow-up. The study received IRB approval. Appropriate statistics were used.
RESULTS:
At baseline, patients from the intervention and control groups had similar characteristics; 43 and 41 patients, respectively, completed the 6-month follow-up period. PROs worsening at 6 months of follow-up were similar between groups, as were the DAS28-ESR and the proportion of patients who flared. In general, MUS findings were in accordance with the clinical remission status, although power Doppler synovitis was detected in up to 37% of the patients. RA-related treatment was increased in all the patients from the intervention group with discordant findings between clinical and MUS assessments.
CONCLUSIONS:
The addition of MUS to clinical evaluation of RA outpatients in remission did not prevent worsening PROs at 6 months.

Rheumatology Article