Ultrasound of metacarpophalangeal joints is a sensitive and reliable endpoint for drug therapies in rheumatoid arthritis: Results of a randomized, two-centre, placebo-controlled study
IntroductionWe aimed to investigate the sensitivity and reliability of 2D ultrasonographic endpoints at the metacarpophalageal joints (MCPJs) and their potential to provide an early and objective indication of a therapeutic response to treatment intervention in rheumatoid arthritis (RA).
A randomized, double-blind, parallel-group, two-centre, placebo-controlled trial investigated the effect on ultrasonographic measures of synovitis of repeat dose oral prednisone; 15mg or 7.5mg, each compared to placebo, in consecutive 2-week studies; 18 subjects in a 1:1 ratio and 27 subjects in a 2:1 ratio respectively. All subjects met the 1987 American College of Rheumatology criteria for the diagnosis of RA, were [greater than or equal to]18 years-old with RA disease duration [greater than or equal to]6 months, and had a Disease Activity Score 28 based on C-reactive protein ( DAS28-CRP) [greater than or equal to]3.2.
Subjects underwent high-frequency (gray-scale) and power Doppler ultrasonography at Days 1 (baseline), 2, 8 and 15 in the dorsal transverse and longitudinal planes of all 10 MCPJs to obtain summated scores of quantitative and semi-quantitative measures of synovial thickness as well as vascularity. The primary endpoint was the summated score of power Doppler area measured quantitatively in all 10 MCPJs in the transverse plane at Day 15.
Clinical efficacy was assessed at the same time points by DAS28(CRP).
All randomized subjects completed the trial. The comparison between daily 15 mg prednisone and placebo at Day 15 yielded a statistically significant treatment effect (effect size=1.02, P=0.019) in change from baseline in the primary endpoint, but borderline for prednisone 7.5 mg daily vs.
placebo (effect size=0.61, P=0.071). A significant treatment effect for (DAS28-CRP) was only observed at Day 15 in the prednisone 15mg group (effect size=0.95, P=0.032).
However, significant treatment effects at all time points for a variety of ultrasound endpoints were detected with both prednisone doses; the largest observed effect size=2.33. Combining ultrasound endpoints with (DAS28-CRP) improved the registration of significant treatment effects.
The parallel scan inter-reader reliability of summated 10 MCPJ scores were good to excellent (ICC values >0.61) for the majority of ultrasound measures.
Ultrasonography of MCPJs is an early, reliable indicator of therapeutic response in RA with potential to reduce patient numbers and length of trials designed to give preliminary indications of efficacy.Trial Registration: Clinicaltrials.gov identifier: NCT00746512
Author: Matthew W SeymourStephen KellyChan R BealsMarie-Pierre J MaliceJames A BologneseBernard J DardzinskiAmy S ChengCorinne E CummingsSteven S SmugarCatherine McClintonAmy FoxWilliam DooleyCostantino PitzalisPeter C Taylor Credits/Source: Arthritis
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