In a nutshell
This study investigated the effectiveness of combined ultrasound for assessing synovitis in rheumatoid arthritis (RA) patients starting abatacept (Orencia) with methotrexate (Trexall). The study concluded that the ultrasound technique and the drug combination were effective.
Some background
RA is a chronic autoimmune disease (when the immune system attacks healthy tissue) that causes pain, stiffness, swelling and restricted movement in the joints. In RA, the joint membranes become inflamed (this is called synovitis). The first treatment generally tried in RA patients is MTX. Abatacept is a new drug for the treatment of RA, and in previous trials has been shown to be effective on its own, or combined with MTX.
Power Doppler and greyscale ultrasound (PDUS) is a promising, non-invasive imaging method used to assess synovitis. PDUS could be used instead of MRI (magnetic resonance imaging, which uses magnetic fields to image inside the body), which some patients find uncomfortable.
Methods & findings
In this study, PDUS was used to assess the effectiveness of abatacept with MTX on synovitis.
Eighty-nine patients with active RA received 10mg/kg abatacept plus MTX (at least 15mg/kg) at day 1, and at weeks 2, 4, 8, 12, 16, 20, and 24. At each visit, 22 specific, paired joints were scanned.The presence of synovitis in the joints was assessed using PDUS.
Improvements were seen with PDUS at week 1, with continuous improvements until week 24. At 12 weeks, disease activity improvements were seen in 19%-40% of patients. At 24 weeks, improvement was seen in 41%-57% of patients. Remission (no disease activity) at 24 weeks was 11%, with a further 22% achieving three of the four criteria for remission.
The bottom line
The study concluded that abatacept was safe and effective, and that ultrasound was an objective tool to monitor patients with RA and an alternative to MRI scans.
The fine print
There was no control group for comparison. The effects of using different joint sets is unclear.
What’s next?
If you have RA and do not like MRI scans, or if MTX is not working for you, you should discuss these results with your doctor.
Published By :
Annals of the rheumatic diseases
Date :
Nov 20, 2015
