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ORIGINAL RESEARCH article

Front. Med.
Sec. Rheumatology
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1459802

Contrast-enhanced ultrasound as a valuable tool to detect minimal inflammation in RA patients in sustained remission

Provisionally accepted
Joaquim Polido Pereira Joaquim Polido Pereira 1,2*Manuel Silvério António Manuel Silvério António 1,2Nikita Khmelinskii Nikita Khmelinskii 1,2Marta Arese Marta Arese 3Rui Lourenço Teixeira Rui Lourenço Teixeira 1,2Elsa Cristina Vieira-Sousa Elsa Cristina Vieira-Sousa 1,2Maria Antonietta D'Agostino Maria Antonietta D'Agostino 4João Eurico Fonseca João Eurico Fonseca 1,2
  • 1 Rheumatology Department, Santa Maria Hospital, Lisbon, Portugal
  • 2 Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Lisbon, Portugal
  • 3 Agostino Gemelli University Polyclinic (IRCCS), Rome, Lazio, Italy
  • 4 Division of Rheumatology, Agostino Gemelli University Polyclinic (IRCCS), Rome, Sicily, Italy

The final, formatted version of the article will be published soon.

    Objective: The study aimed to explore the utility of contrast-enhanced ultrasound (CEUS) as a tool for detecting minimal inflammation in rheumatoid arthritis (RA) patients in sustained remission (SR) and to correlate findings with Disease Activity Score 28 (DAS28) status scores and various ultrasound (US) scores.Patients and Methods: Thirty RA patients in SR (minimum 6 months), 12 with active disease, and 10 healthy controls were included. Clinical evaluations and US assessments were performed, including greyscale US (GSUS), power Doppler US (PDUS), and Global OMERACT-EULAR synovitis score (GLOESS). CEUS was performed in the two most active joints and was scored semiquantitatively (SQ) and quantitatively.Results: Healthy controls and remission RA patients had similar total US scores. Active RA patients had higher US scores than healthy and remission groups, with statistically significant differences in all groups compared to healthy but only in GSUS and GLOESS when compared with remission.Ninety-five joints were selected for CEUS, and we detected more microvascularisation with the SQ CEUS score than with PDUS in all groups (18 vs 58% in the remission group; p-value 0.006). The weighted Cohen's kappa for intra-rater and inter-rater IACUS CEUS score was 0,714 (confidence interval 0,610-0,819, p-value <0,001) and 0,540 (confidence interval 0,419-0,662, p-value <0,001), respectively. The Spearman's correlation between the SQ CEUS and quantitative score was 0.655.For most RA patients in SR, conventional US may fail to detect microvascularisation potentially related to the subclinical disease. CEUS may be helpful for this purpose.

    Keywords: Rheumatoid arthritis, remission, Ultrasonography, Microbubbles, synovium

    Received: 04 Jul 2024; Accepted: 26 Nov 2024.

    Copyright: © 2024 Polido Pereira, Silvério António, Khmelinskii, Arese, Teixeira, Vieira-Sousa, D'Agostino and Fonseca. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Joaquim Polido Pereira, Rheumatology Department, Santa Maria Hospital, Lisbon, Portugal

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.