Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study

PURPOSE: To evaluate by using B-mode and power Doppler ultrasonography (US) and
clinical assessment the response of hand joint synovitis in patients with active
rheumatoid arthritis (RA) to treatment with the anti-tumor necrosis factor-alpha
agent infliximab. MATERIALS AND METHODS: Wrists, metacarpophalangeal (MCP)
joints, and proximal interphalangeal (PIP) joints in 11 patients with active RA
were assessed before and 6 weeks after three infliximab infusions. US assessment
was performed at a single site in the MCP and PIP joints and at two sites
(radiocarpal and intercarpal) in the wrists. Twenty measurements were performed
in the wrists; 110 measurements, in the MCP joints; and 103 measurements, in the
PIP joints. Two wrists and seven PIP joints were excluded owing to complete joint
destruction. US parameters (synovial thickness, number of US-positive joints [ie,
with synovial thickness > or = 1 mm], cumulative synovial thickness index, and
presence of Doppler signal) and clinical parameters (swollen joint count) were
independently assessed and compared with baseline values by using the McNemar
chi2 and paired Student t tests. RESULTS: After infliximab treatment, there was a
significant decrease in the mean numbers of swollen and US-positive joints and in
the cumulative synovial thickness (P <.05). The mean synovial thickness decreased
in all joints swollen at baseline and in the MCP and PIP joints not swollen at
baseline (P <.01). Change from baseline cumulative synovial thickness correlated
significantly with change in disease activity score (r = 0.69, P <.05). The
number of positive Doppler US signals decreased significantly (in 13 US-positive
joints at baseline, in five after treatment; P <.05). CONCLUSION: US is a
feasible imaging modality for measurement of the response of RA small-joint
synovitis to therapy.