Little Difference Between MSUS and DAS28-driven Treatment Strategies for Rheumatoid Arthritis

In early rheumatoid arthritis (RA), musculoskeletal ultrasound (MSUS)-driven treat-to-target strategies may led to more intensive treatment than disease activity score in 28 joints (DAS28)-driven strategies, but not better clinical or imaging outcomes, according to a study published in the Annals of Rheumatic Diseases.

For the study, researchers led by Led by James Dale, MD, Wishaw General Hospital (North Lanarkshire, United Kingdom), randomly assigned 111 patients with newly diagnosed RA or undifferentiated arthritis to be treated with strategies aimed at attaining either a DAS28-erthrocyte sedimentation rate (ESR) less than 3.2 or a total power Doppler joint count of less than or equal to 1 during a combined DAS28-ESR and MSUS assessment.
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MRI of dominant hand and wrist, and plain radiographs of hands and feet were undertaken at baseline and 18 months for grading by two readers using the Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis MRI Scoring System (RAMRIS) and van der Heijde/Sharp Score, respectively. The primary outcomes of the study were mean change from baseline of DAS44 and RAMRIS erosion score.

Overall, researchers found that there were significant improvements in DAS44 scores for both treatment arms, with a mean change of -2.58 for those assigned to the DAS28-ESR group and a -2.69 change in the MSUS group. Additionally, DAS44 remission at 18 months was 44% and 66% for these same groups, respectively. However, there was no significant difference among any of the other American College of Rheumatology core set variables. Researchers also reported that there were limited MRI erosions and MRI progressions as well as no serious adverse events or imaging outcomes.

Therefore, researchers concluded that MSUS-driven treat-to-target strategies may provide more intensive treatment for patients with early RA compared with DAS28-driven strategies, but not improved clinical or imaging outcomes.