Rheumatology International

, Volume 39, Issue 6, pp 1019–1025 | Cite as

Power-Doppler perfusion phenotype in RA patients is dependent on anti-citrullinated peptide antibody status, not on rheumatoid factor

  • O. GadeholtEmail author
  • M. Feuchtenberger
  • T. Wech
  • E. C. Schwaneck
Observational Research


It is not known whether there are any consistent non-serological differences between seropositive and seronegative rheumatoid arthritis, and if any, whether they depend upon rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA), or both. In a pilot study, we showed that the two forms could be differentiated using power-Doppler sonography (PDS), and that the difference is ACPA dependent. This extended study explored whether the previous findings could be confirmed. 103 patients 51 ACPA positive (ACPA +), 52 ACPA negative (ACPA −) with active wrist arthritis were examined using PDS. By means of a temporal image series, pulsatility was evaluated over a 3–5-s period, maximum and minimum perfusion signal were determined using a computer program counting the number of coloured pixels for each frame. Maxima (Pmax) and minima (Pmin) were determined, and the standardized peak-to-peak amplitude sA was calculated (sA = (Pmax − Pmin)/Pmax). This parameter was then compared for ACPA + and ACPA- patients. In addition, a multivariate regression was performed, to determine which factors influence sA. sA differed significantly between ACPA + and ACPA- patients [20% (13–26) vs. 41% (32–57), p < 0. 0001]. In the multivariate analysis, age (t = 2.5, p = 0.02) and ACPA status (t = − 4.8, p < 0.0001) were independent predictors of sA. PDS perfusion patterns are different in seropositive and seronegative RA. The difference appears to be ACPA, not RF dependent. This suggests that the underlying pathophysiological process is different in ACPA-positive and ACPA-negative RA.


Power-Doppler sonography ACPA-negative RA Perfusion pattern 



The authors would like to thank Hans-Peter Tony MD, PhD for his input in drafting the manuscript, and Tobias Müller for assistance with performing the multivariate regression. No external writers were involved in manuscript drafting or preparation.

Author contributions

OG: underlying observation, study design, patient recruitment, sonographic examination, data analysis, data interpretation, and first draft; MF: patient recruitment, sonographic examination, and draft revision; TW: data preparation, data post-processing, and draft revision; ECS: study design, patient recruitment, sonographic examination, data interpretation, and draft revision.


No external funding was obtained for performing this study.

Compliance with ethical standards

Conflict of interest

OG: speaker’s fees from Abbvie, Chugai, Janssen-Cilag, Novartis, and Sanofi. Grants from Abbvie, Chugai, Janssen-Cilag, Lilly, Novartis and Roche. Advisory board participation for Novartis. All outside the submitted work. MF: personal Fees from Abbvie, Chugai, Janssen-Cilag MSD, Pfizer, Roche and UCB. All outside the submitted work. TW: research grant from Siemens Healthcare. Outside the submitted work. ECS: speaker’s fees from Abbvie, Chugai, Jansen-Cilag, Lilly, Novartis and Shire. Grants from Abbvie, Celgene, Chugai, Novartis and Shire. All outside the submitted work.

Ethics approval

Final approval by the ethics committee of the University of Würzburg, Würzburg, Germany 20.07.2018 (Protocol Number 22/18). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Data sharing

No application was submitted to the ethics commission of the University of Würzburg for permission to share the obtained data. Hence, the data cannot be made available for further analysis.

Supplementary material

296_2019_4256_MOESM1_ESM.avi (706 kb)
Supplementary material 1 (AVI 706 KB)
296_2019_4256_MOESM2_ESM.avi (995 kb)
Supplementary material 2 (AVI 995 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Rheumatology, Medical Clinic IIUniversity Clinic WürzburgWürzburgGermany
  2. 2.Rheumatologische Schwerpunktpraxis WürzburgWürzburgGermany
  3. 3.Med I Bayern OstBurghausenGermany
  4. 4.Department of Experimental RadiologyUniversity Clinic WürzburgWürzburgGermany

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