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Adding ultrasound to treat-to-target shows no benefit in achieving clinical remission nor in slowing radiographic progression in rheumatoid arthritis: results from a multicenter prospective cohort

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Abstract

Objective

To assess whether using ultrasound (US) in addition to clinical information versus only clinical information in a treat-to-target (T2T) strategy leads to more clinical remission and to less radiographic progression in RA.

Methods

Patients with RA from the 2-year prospective BIODAM cohort were included. Clinical and US data (US7-score) were collected every 3 months and hands and feet radiographs every 6 months. At each visit, it was decided whether patients were treated according to the clinical definition of T2T with DAS44 remission as benchmark (T2T-DAS44). T2T-DAS44 was correctly applied if: (i) DAS44 remission had been achieved or (ii) if not, treatment was intensified. A T2T strategy also considering US data (T2T-DAS44-US) was correctly applied if: (i) both DAS44 and US remission (synovitis-score < 2, Doppler-score = 0) were present; or (ii) if not, treatment was intensified. The effect of T2T-DAS44-US on attaining clinical remission and on change in Sharp-van der Heijde score compared to T2T-DAS44 was analysed.

Results

A total of 1016 visits of 128 patients were included. T2T-DAS44 was correctly followed in 24% of visits and T2T-DAS44-US in 41%. DAS44 < 1.6 was achieved in 39% of visits. Compared to T2T-DAS44, using the T2T-DAS44-US strategy resulted in a 41% lower likelihood of DAS44 remission [OR (95% CI): 0.59 (0.40;0.87)] and had no effect on radiographic progression [β(95% CI): 0.11 (− 0.16;0.39)] assessed at various intervals up to 12 months later.

Conclusion

Our results do not suggest a benefit of using the US7-score in addition to clinical information as a T2T benchmark compared to clinical information alone.

Key Points

• Ultrasound has a valuable role in diagnostic evaluation of rheumatoid arthritis, but it is unclear whether adding ultrasound to the clinical assessment in a treat-to-target (T2T) strategy leads to more patients achieving remission and reduction in radiographic progression.

• Our data from a real-world study demonstrated that adding information from ultrasound to the clinical assessment in a T2T strategy led to a lower rather than a higher likelihood of obtaining clinical remission as compared to using only clinical assessment.

• Our data demonstrated that adding ultrasound data to a T2T strategy based only on clinical assessment did not offer additional protection against radiographic progression in patients with RA.

• Adding US to a T2T strategy based on clinical assessment led to far more treatment intensifications (with consequences for costs and exposure to adverse events) without yielding a meaningful clinical benefit.

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Data availability

All data pertaining to this study are available in the article and supplementary material.

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Acknowledgements

The authors sincerely thank all patients, the staff and all recruiting rheumatologists of the RA BIODAM study.

Author information

Authors and Affiliations

  1. Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands

    Alexandre Sepriano, Sofia Ramiro & Désirée van der Heijde

  2. NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal

    Alexandre Sepriano

  3. Zuyderland Medical Center, Heerlen, The Netherlands

    Sofia Ramiro & Robert Landewé

  4. Amsterdam University Medical Center (ARC), Amsterdam, The Netherlands

    Robert Landewé

  5. Department of Internal Medicine - Rheumatology and Clinical Immunology, Academic Hospital of Charité – Universitätsmedizin Berlin, Parkklinik Weissensee, Berlin, Germany

    Sarah Ohrndorf

  6. Department of Rheumatology, St. Vincent’s University Hospital, Dublin, Ireland

    Olivier FitzGerald

  7. Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland

    Olivier FitzGerald

  8. Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Marina Backhaus & Gerd Burmester

  9. Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Canada

    Maggie Larché

  10. Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, T6G 2S2, Canada

    Joanne Homik & Walter P. Maksymowych

  11. LBAI, U1227, University of Brest, Inserm; CHRU Brest, F-29200, Brest, France

    Alain Saraux

  12. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

    Hilde B. Hammer

  13. Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark

    Lene Terslev & Mikkel Østergaard

  14. Departement de Rhumatologie, Univ Montpellier, CHU Montpellier, Montpellier, France

    Bernard Combe

  15. Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France

    Maxime Dougados

  16. Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada

    Carol Hitchon

  17. Division of Rheumatology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke (CIUSSS de l’Estrie – CHUS), Université de Sherbrooke, Québec, Canada

    Gilles Boire

  18. Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada

    Robert G. Lambert

  19. Medical Imaging Consultants, Edmonton, Canada

    Robert G. Lambert

  20. CARE ARTHRITIS LTD, Edmonton, Canada

    Rana Dadashova, Joel Paschke, Edna J. Hutchings & Walter P. Maksymowych

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  1. Alexandre Sepriano
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  2. Sofia Ramiro
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Contributions

All authors made contributions to conception and/or implementation of the study, were involved in reviewing and revising the manuscript, and gave final approval to the version to be published.

Corresponding author

Correspondence to Walter P. Maksymowych.

Ethics declarations

Conflict of interest

Alexandre Sepriano: speaking and/or consulting fees from Novartis, Abbvie, UCB and Lilly.

Sofia Ramiro: research grants and/or consultancy fees: AbbVie, Eli Lilly, MSD, Novartis, Sanofi

Robert Landewé: Received consulting fees from AbbVie, BMS, Celgene, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Roche, UCB and is Director of Rheumatology Consultancy bv

Désirée van der Heijde: Received consulting fees from AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma and is Director of Imaging Rheumatology bv.

Sarah Ohrndorf: Received consulting fees from AbbVie, BMS, Novartis, and Roche

Olivier FitzGerald: Has received research grants and/or consultancy fees: AbbVie, Eli Lilly, Celgene, Novartis, UCB, Pfizer, Amgen, Janssen

Marina Backhaus: Has received research grant and/or consultancy fees: Abbvie, BMS, Celgene, Lilly, MSD, Novartis, Pfizer, Roche, UCB

Maggie Larche: Received advisory board honoraria from AbbVie, Actelion, Boehringer Ingelheim, BMS, Janssen, Novartis, Pfizer, Sanofi, Roche; and an unrestricted educational grant from AbbVie

Joanne Homik: None

Alain Saraux: Research grants and/or consultancy fees by: AbbVie, BMS, Chugai, Eli Lilly, MSD, Nordic pharma, Novartis, Pfizer, Sanofi, UCB

Hilde B. Hammer: Has received fees for speaking and/or consulting from AbbVie, BMS, Pfizer, UCB, Roche, MSD and Novartis.

Lene Terslev: Received speakers fee from Janssen, Roche, Novartis, UCB, MSD, BMS and GE

Mikkel Østergaard: Has received research support, consultancy fees and/or speaker fees from Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB

Gerd Burmester: Honoraria as speaker and for consulting: Abbvie, BMS, Gilead, Lilly, MSD, Pfizer, UCB, Roche, Sanofi

Bernard Combe: Received consulting fees from AbbVie, BMS, Celltrion, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pfizer, Roche-Chugai.

Maxime Dougados: Has received research grants from and honorarium fees for his participation at advisory boards and/or symposium organized by PFIZER, UCB, ABBVIE, LILLY, NOVARTIS, BMS, ROCHE, UCB, MERCK.

Carol Hitchon: Has received unrelated research grants from Pfizer, UCB

Gilles Boire: Received consulting fees from Eli Lilly, Janssen, Novartis, Pfizer, Samsung Bioepis, Viatris, and speaker fees from BMS, Merck, Pfizer. Industry support for investigator-initiated research initiatives from Abbvie, BMS, Eli Lilly, Janssen, Merck, Pfizer, Roche

Robert G. Lambert: Received consulting fees from Calyx, Care Arthritis and Image Analysis Group.

Rana Dadashova: Senior Project Manager for CARE ARTHRITIS LTD

Joel Paschke: none

Edna J. Hutchings: none

W.P. Maksymowych: Received consulting fees from AbbVie, Boehringer Ingelheim, Celgene, Eli-Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB Pharma and is Chief Medical Officer of CARE ARTHRITIS LTD

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Sepriano, A., Ramiro, S., Landewé, R. et al. Adding ultrasound to treat-to-target shows no benefit in achieving clinical remission nor in slowing radiographic progression in rheumatoid arthritis: results from a multicenter prospective cohort. Clin Rheumatol (2024). https://doi.org/10.1007/s10067-024-06978-5

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  • DOI: https://doi.org/10.1007/s10067-024-06978-5

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