Association of Intra-erosive Power Doppler Signals Detected by Musculoskeletal Ultrasound with 1-year Radiographic Progression in Early Rheumatoid Arthritis.

Abstract

This study aimed to investigate the clinical and ultrasonographic factors associated with radiographic progression at 1 year after treatment initiation in patients with treatment-naïve rheumatoid arthritis (RA). We consecutively enrolled treatment-naïve RA patients who presented to our hospital between January 2018 and December 2023. Clinical disease activity indices, musculoskeletal ultrasound (MSUS) findings of 22 joints in the hands and wrists, and radiographic findings were evaluated at baseline and at the 1-year follow-up. The data were analyzed retrospectively. A total of 265 patients were included. The median duration from symptom onset to treatment initiation was 3.6 months. Baseline disease activity was moderate, with mean SDAI and CDAI values of 21.2 and 19.5, respectively. All patients initiated treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs), and treatment was managed according to a treat-to-target strategy. At 1 year after the treatment initiation, 110 patients (41.5%) received biologic or targeted synthetic DMARDs. Concurrently, 215 patients (81.1%) maintained radiographic remission of the hands and wrists (defined as change in modified total Sharp score [Δ hand/wrist mTSS] ≤ 0.5/year). Multivariate logistic regression analysis showed significant association between clinical factors, including disease activity indices, and radiographic progression. The presence of power Doppler signals penetrating into bone erosions was the only independent factor associated with lower odds of maintained structural remission (OR 0.20; 95% CI 0.09-0.46; P < 0.001). In treatment-naïve RA patients, the presence of intra-erosive power Doppler signals on MSUS was associated with radiographic progression at 1 year after treatment initiation.