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ObjectiveTo assess the ability of ultrasound to predict successful tapering and successful discontinuation of biological DMARDs (bDMARDs) at the 2-year follow-up in RA patients in sustained remission.MethodsPatients in sustained remission (DAS28-CRP ≤ 2.6) and with no radiographic progression the previous year tapered bDMARDs according to a standardized regime. A total of 119 of these patients were included in this ultrasound substudy. At baseline, clinical assessment, MRI, X-ray and ultrasound of 24 joints were performed. Ultrasound-detected synovitis was defined and scored 0-3 using the OMERACT scoring system at the joint level for both grey-scale and Doppler activity. Sum scores for each ultrasound modality were calculated for 24 joints at the patient level. The final state of treatment was assessed after 2 years. The predictive value of ultrasound measures for successful tapering and discontinuation at the 2-year follow-up was assessed via logistic regression analyses.ResultsNegative IgM-RF [odds ratio (OR) = 0.29, 95% CI: 0.10-0.85; P = 0.024] and lower Doppler sum score of 24 joints (OR = 0.44, 95% CI: 0.15, 0.87; P = 0.014) were independent predictors for successful discontinuation of bDMARDs at the 2-year follow-up. The predictive value of the Doppler sum score was independent of MRI findings. Previous numbers of bDMARDs were predictive of successful tapering (OR = 0.58, 95% CI: 0.35, 0.91; P = 0.018), whereas ultrasound was not. Clinical parameters were not predictive of successful tapering/discontinuation.ConclusionDoppler sum score was an independent predictor for successful discontinuation of bDMARDs at the 2-year follow-up-the odds for achieving successful discontinuation decreased by 56% per one-unit increase in Doppler sum score. Ultrasound could not predict successful tapering.

Original publication

DOI

10.1093/rheumatology/keab276

Type

Journal article

Journal

Rheumatology (Oxford, England)

Publication Date

12/2021

Volume

60

Pages

5549 - 5559

Addresses

Center for Rheumatology and Spine Diseases, Center of Head and Orthopaedics, Glostrup, Rigshospitalet, Capital Region, Denmark.

Keywords

Humans, Arthritis, Rheumatoid, Antirheumatic Agents, Biological Products, Magnetic Resonance Imaging, Radiography, Ultrasonography, Doppler, Withholding Treatment, Remission Induction, Retrospective Studies, Follow-Up Studies, Predictive Value of Tests, Algorithms, Time Factors, Aged, Middle Aged, Female, Male