Doppler sonographic evaluation of effect of treatment with infliximab (Remicade) for rheumatoid arthritis

Tracking rheumatic disease through imaging

This review recounts the historical, current, and future involvement of radiology and imaging in the diagnosis, management, and follow-up of patients with various rheumatic conditions. Radiographs are the mainstay of imaging patients with rheumatic conditions, although magnetic resonance imaging and ultrasonography are routinely used for early diagnosis of disease. Computed tomography remains useful in evaluating the extent of involvement of inflammatory spondyloarthropathies that classically involve the axial skeleton and sacroiliac joints. Molecular imaging has begun to play an innovative role in evaluating patients with arthritis, aiming to identify disease earlier and provide greater specificity.

Doppler sonographic analysis of synovial vascularization in a patient with rheumatoid arthritis treated with leukocytapheresis

Synovial vascularization in metacarpophalangeal joints of a patient with rheumatoid arthritis treated with leukocytapheresis (LCAP) was evaluated by Doppler sonography. After the treatment with LCAP, evaluation with American College of Rheumatology core set showed improvement, and the levels of C-reactive protein and serum amyloid A protein decreased. Power Doppler sonography demonstrated a reduction of color flow signals of the joints, and spectral Doppler sonography demonstrated an increase in vascular resistant, indicating a reduction of vessel's permeability. This is the first report evaluating a synovial vascularization and blood flow of the joints by Doppler sonography before and after LCAP therapy. Doppler sonography might be one of the useful methods for evaluating the therapeutic response of LCAP.

Reliability of different Doppler ultrasound quantification methods and devices in the assessment of therapeutic response in arthritis

OBJECTIVE

To evaluate the metric qualities of power Doppler ultrasound (PDUS) for different quantification methods and devices in the assessment of arthritis during anti-inflammatory treatment.

METHODS

Twenty-four patients with active arthritis and first-time treatment with the TNF-alpha inhibitor adalimumab underwent sequential clinical, laboratory and US examination at baseline, weeks 2, 6 and 12. 2D and 3D PDUS was performed by two independent investigators. The images and movies were scored from 0 to 3 and the amount of colour pixels and voxels was calculated. In addition, the resistance index of a synovial artery was measured. Thirteen patients were examined with a second US machine.

RESULTS

Treatment response was already observed at week 2 with a significant reduction of 2D (P < 0.01) and 3D scores (P < 0.001). A moderate correlation to 28-joint disease activity score was found for 3D voxel count (r(s) = 0.35, P < 0.001). Interobserver agreement was kappa or ICC >or= 0.8 for all methods except the resistance index (ICC = 0.60). Intermachine agreement was kappa = 0.57 for 2D PDUS score.

CONCLUSIONS

The study demonstrates good to excellent interobserver and moderate intermachine reliability of different PDUS assessment methods in a longitudinal open-label study.