Ultrasound of the hand is sufficient to detect subclinical inflammation in rheumatoid arthritis remission

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Rheumatoid arthritis (RA) is an autoimmune disease marked by deformity of joints leading to disability. Early diagnosis of this inflammatory disease seems to be crucial to optimal therapeutic management. Ultrasound is considered one of the fundamental imaging methods for identifying joint or tendon aggravation in patients with RA. However, there is no consensus regarding the minimum number of joints that should be included in an ultrasound scoring system to reliably assess for disease activity in rheumatoid arthritis. To enhance the use of ultrasound as a reliable imaging technique for assessing inflammation, fewer joint counts have been proposed with only joints in the hands as the most convenient in examination. Subclinical inflammation is regularly found in patients with RA in composite score remission.

Is it really possible to have a simplified proposal of using only ultrasound hand examination and showing it as informative as the examination of 36 joints in patients with RA, with good correlation of the ultrasound parameters with disease activity (DAS-28)? On this note, Hilde Berner Hammer and Tore Kvien from the Department of Rheumatology at Diakonhjemmet Hospital in Norway in collaboration with Lene Terslev from the Centre for Rheumatology and Spinal Diseases at Copenhagen University Hospital Rigshospitalet in Denmark investigated whether ultrasound of just the hands is adequate in detecting subclinical inflammation in patients with established RA in clinical remission. The research team inspected an cohort of 209 patients with established RA while starting biologic medication against RA, and the patients were followed for one year.  They found that > 90% of the patients with subclinical inflammation was distinguished by the presence of power Doppler in the hands. The research work is published in Journal Arthritis Research & Therapy.

The investigators successfully demonstrated that in patients with established RA on bDMARD treatment and in composite score clinical remission, ultrasound examination of just the hands is adequate to recognize > 90% of patients with subclinical inflammation. These findings highlight the importance of ultrasound imaging of only the hands in a routine clinical setting for this patient group.

“The implication of this study is that in established RA patients in clinical remission, US of the hands (which is highly feasible, taking < 5 minutes), will help the clinician to evaluate whether the patient is in imaging remission. The clinical composite scores may not be optimal at patient level, and thus this rapid US assessment will guide the clinician in optimizing the treatment”. Said Dr. Hammer


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Specialist in internal medicine and rheumatology, and senior consultant at Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. She has special interest in ultrasonography, pain and biomarkers.

Dr. Hammer is highly involved in ultrasound education both on national and international bases and is in charge of the US education during the obligatory course on imaging for specialist candidates in rheumatology in Norway. She has been in the faculty of EULAR ultrasonography courses from 2006 and is in the faculty of several other international US courses (i.e. lectures and US teacher on the EULAR sonography courses) as well as in the OMERACT US group. Dr. Hammer has been in charge of a large number of national US studies and has collaborates with the international US society by performing several multicenter US studies. She has authored more than 90 articles in peer reviewed journals.

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Hilde Berner Hammer, Tore K. Kvien, Lene Terslev. Ultrasound of the hand is sufficient to detect subclinical inflammation in rheumatoid arthritis remission: a post hoc longitudinal study. Arthritis Research & Therapy, 2017, Volume 19, 221