Power Doppler Ultrasound Detects Early Synovitis Change in APPRAISE Study Save

While new recommendations suggest early aggressive management of rheumatoid arthritis, our ability to assess treatment response is limited to clinical and laboratory assessment.

Synovitis, an oftent subtle manifestation of RA, ultimately leads to joint erosion, and may be hard to detect without imaging techniques. 

This first prospective international study was designed to assess the capability Power Doppler and greyscale ultrasound (PDUS) to measure the early effect and time course of response to treatment with abatacept in biologic-naïve patients with active RA despite methotrexate (MTX).

The APPRAISE (NCT00767325) study was a 24-week, phase IIIb, open-label, multicenter, single-arm study conducted at 21 sites across Europe (Denmark, France, Germany, Hungary, Italy, Norway, Spain and the UK). In this study patients with RA (MTX inadequate responders) received intravenous abatacept (∼10 mg/kg) plus MTX for 24 weeks. A composite PDUS synovitis score, developed by the Outcome Measures in Rheumatology–European League Against Rheumatism (OMERACT–EULAR)-Ultrasound Task Force, was used to evaluate individual joints.

The earliest PDUS sign of improvement in synovitis was observed as early as week 1; with a mean (95% CI) change from baseline in Global OMERACT–EULAR Synovitis Score (GLOESS) (MCPs 2–5) of −0.7 (−1.2 to −0.1). Early improvement was observed in the component scores (power Doppler signal at week 1, synovial hyperplasia at week 2, joint effusion at week 4).

This study concluded the OMERACT–EULAR composite PDUS score in biologic-naïve RA patients treated with abatacept, is capable of detecting early synovitis changes detectable as early as 1 week. PDUS can be potentially used to predict clinical response early in treatment course and allow for early treatment adjustment to improve long term outcomes.