Display options
Cite
Terslev L, Brahe CH, Hetland ML, et al. Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission. Rheumatology (Oxford). 2021;60(12):5549-5559doi: 10.1093/rheumatology/keab276.
Terslev, L., Brahe, C. H., Hetland, M. L., Georgiadis, S., Ellegaard, K., Juul, L., Huynh, T., Døhn, U. M., Fana, V., Møller, T., Krabbe, S., Ørnbjerg, L. M., Glinatsi, D., Røgind, H., Hansen, A., Nørregaard, J., Jacobsen, S., Jensen, D. V., Manilo, N., Asmussen, K., Boesen, M., Rastiemadabadi, Z., Morsel-Carlsen, L., Møller, J. M., Krogh, N. S., & Østergaard, M. (2021). Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission. Rheumatology (Oxford, England), 60(12), 5549-5559. https://doi.org/10.1093/rheumatology/keab276
Terslev, Lene, et al. "Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission." Rheumatology (Oxford, England) vol. 60,12 (2021): 5549-5559. doi: https://doi.org/10.1093/rheumatology/keab276
Terslev L, Brahe CH, Hetland ML, Georgiadis S, Ellegaard K, Juul L, Huynh T, Døhn UM, Fana V, Møller T, Krabbe S, Ørnbjerg LM, Glinatsi D, Røgind H, Hansen A, Nørregaard J, Jacobsen S, Jensen DV, Manilo N, Asmussen K, Boesen M, Rastiemadabadi Z, Morsel-Carlsen L, Møller JM, Krogh NS, Østergaard M. Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission. Rheumatology (Oxford). 2021 Dec 01;60(12):5549-5559. doi: 10.1093/rheumatology/keab276. PMID: 33748831.
Copy Download .nbib Format: NLM
Share it on

Rheumatology (Oxford). 2021 Dec 01;60(12):5549-5559. doi: 10.1093/rheumatology/keab276.

Doppler ultrasound predicts successful discontinuation of biological DMARDs in rheumatoid arthritis patients in clinical remission.

Rheumatology (Oxford, England)

Lene Terslev, Cecilie Heegaard Brahe, Merete Lund Hetland, Stylianos Georgiadis, Karen Ellegaard, Lars Juul, Tuan Huynh, Uffe Møller Døhn, Viktoria Fana, Torsten Møller, Simon Krabbe, Lykke Midtbøll Ørnbjerg, Daniel Glinatsi, Henrik Røgind, Anette Hansen, Jesper Nørregaard, Søren Jacobsen, Dorte Vendelbo Jensen, Natalia Manilo, Karsten Asmussen, Mikael Boesen, Zoreh Rastiemadabadi, Lone Morsel-Carlsen, Jakob Møllenbach Møller, Niels Steen Krogh, Mikkel Østergaard

Affiliations

  1. Center for Rheumatology and Spine Diseases, Center of Head and Orthopaedics, Glostrup, Rigshospitalet, Capital Region, Denmark.
  2. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  3. DANBIO Registry, Center for Rheumatology and Spine Diseases, Center of Head and Orthopaedics, Glostrup, Rigshospitalet, Capital Region, Denmark.
  4. The Parker Institute, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.
  5. Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Gentofte, Rigshospitalet, Denmark.
  6. Holte Rheumatology Clinic, Holte, Capital Region, Denmark.
  7. Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden.
  8. Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  9. Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Frederiksberg,, Denmark.
  10. Department of Radiology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.
  11. Department of Radiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark.
  12. Zitelabs Aps, Copenhagen, Denmark.

PMID: 33748831 DOI: 10.1093/rheumatology/keab276

Abstract

OBJECTIVE: To 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.

METHODS: Patients 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.

RESULTS: Negative 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.

CONCLUSION: Doppler 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.

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].

Keywords: Doppler; T2T strategy; bDMARD; clinical remission; discontinuation; synovial hypertrophy; tapering; ultrasound; ultrasound remission

Publication Types

Grant support