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Predictor of Hand Radiological Progression in Patients With Rheumatoid Arthritis Receiving TNF Antagonist Therapy by Change in Grayscale Synovitis—A Preliminary Study

Chen, Ying-Chou MD*; Su, Fu-Mei MD*; Hsu, Shih-Wei MD; Chen, Jia-Feng MD*; Cheng, Tien-Tsai MD*; Lai, Han-Ming MD*; Chiu, Wen-Chan MD*

JCR: Journal of Clinical Rheumatology: March 2017 - Volume 23 - Issue 2 - p 73–76
doi: 10.1097/RHU.0000000000000516
Original Articles

Objectives 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.

From the Departments of *Rheumatology, and †Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

The authors declare no conflict of interest.

Author contributions: Ying-Chou Chen designed and performed the research; Shih-Wei Hsu scored radiographs. Jia-Feng Chen performed ultrasound. Fu-Mei Su analyzed data, Tien-Tsai Cheng, Han-Ming Lai, Wen-Chan Chiu provided RA care. Ying-Chou Chen wrote the final paper.

This study was supported by Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung grant CMRPG8A0591.

Correspondence: Ying-Chou Chen, Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan. 123 Ta-Pei Rd, Niao-Sung District, Kaohsiung 833, Taiwan. E-mail:

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