Compared with MRI, ultrasound costs less, is more accessible & offers the ability to scan more joints in a shorter period of time, but the benefits of structured ultrasound examinations in daily care if patients receive optimal treatment have not been demonstrated.
Other Takes
Another recent study, called TaSER (targeting synovitis in early rheumatoid arthritis), also studied whether musculoskeletal ultrasound assessment of disease activity in early RA could improve treat-to-target strategies.4 It found that an ultrasound-
driven treat-to-target strategy in early RA led to more intensive treatment, but not better clinical outcomes than a DAS28-driven strategy.
The ARCTIC researchers, in another recent paper, specifically examined the usefulness of ultrasonography in guiding intra-articular injections and found ultrasound information to be useful when selecting joints for injection.5 “But we found no difference in efficacy of ultrasound vs. palpation-guided injections,” says Dr. Lillegraven.
The major take-home message for rheumatologists from the ARCTIC study is that achieving remission is possible for the majority of RA patients. “We can see so many more of our patients in remission than just 10 years ago. But that’s if you use tight controls and treat to target. We have ended up with better outcomes, which have pushed us toward treat to target, tighter control and specific targets,” Dr. Lillegraven says. “It’s important to treat patients early in the disease and see them often in the beginning while treating to specific targets, even though that approach can be more time consuming. It will produce better long-term results.”
Ten years ago, rheumatologists might have asked their RA patients how they were doing, and if they said they were doing fine, the doctor might not have considered changing their treatments. “Now we’re moving toward more formal approaches and more persistence in changing treatments in order to get our patients into remission,” Dr. Lillegraven says. “We know that being in remission is associated with better long-term results, while not trying to achieve remission leads to worse outcomes.”
But some clinicians might find the recommended targets too stringent, Dr. Lillegraven adds. “Some patients will never reach zero on the global assessment of disease activity scale, and thus would never achieve remission by that standard. That is a limitation of treat to target where established disease is present. For some patients, the target of remission can lead to over-treatment, where low disease activity might be a more appropriate target.”
Larry Beresford is a medical journalist in Oakland, Calif.
