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Baseline Synovial Blood Flow Signals in Very Early Rheumatoid Arthritis is Associated with Joint Inflammation and Radiographic Joint Damage

Hamada S Ahmad, Osama Kombar, Ibrahim Shady, Reham M Shaat and Gamal Othman

Background: Distinguishing which patient with early RA is to run a severe disease course with development of erosions and which is not at baseline evaluation is a major challenge in the management of RA.

Objectives: To assess the changes of the blood flow signals in a total of 2 the studied joints from the start and after one year as well as to predict the future joint damage after one year by assessing the ability of synovial vascularity at baseline measured by power Doppler ultrasound (PDUS).

Patients and Methods: This study was conducted on 34 consecutive early RA patients naive to DMARDs and glucocorticoids who underwent clinical, laboratory, radiologic and ultrasonography (US) assessment at baseline, and 1 year. The degree of US synovial proliferation (US-SP) was investigated in 28 joints using gray-scale ultrasonography. Synovial vascularity was investigated using PDUS and were scored on a 4-grade scale, and the total of the scores in the 28 joints was regarded as the total signal score (US-TSS).

Results: The PD-TSS and US-SP correlated with DAS28-CRP, CRP and radiographic score and to a lesser extent with TJC, SJC and VAS-pain at baseline and one year. PD-TSS and US-SP significantly correlated with HAQ at baseline but not one year. In univariate analysis, the total radiographic score at 1 year and radiographic progression were significantly associated with baseline presence of anti-CCP, presence of RF, US-SP, PD-TSS, radiographic score and the count of joints that had been persistently swollen for the year follow up period. The baseline parameters identified by logistic regression as an independent predictive factor of radiographic score at 1 year and radiographic progression were PD-TSS and radiographic score.

Conclusion: Radiographic score after 1 year and radiographic progression was predicted by baseline synovial vascularity and baseline radiographic score of joint damage. Degree of synovial vascularity and synovial proliferation as measured by ultrasonography are correlated with rheumatoid activity.