The Clinical Utility of Musculoskeletal Ultrasound for Disease Activity Evaluation and Therapeutic Response Prediction in Rheumatoid Arthritis Patients: A Narrative Review

Chia-Ching Chen; Der-Yuan Chen

doi:10.4103/jmu.jmu_126_22

The Clinical Utility of Musculoskeletal Ultrasound for Disease Activity Evaluation and Therapeutic Response Prediction in Rheumatoid Arthritis Patients: A Narrative Review

J Med Ultrasound. 2023 Nov 10;31(4):275-281. doi: 10.4103/jmu.jmu_126_22. eCollection 2023 Oct-Dec.

Authors

Chia-Ching Chen¹, Der-Yuan Chen^{2

3

4

5

6}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Taichung Tsu-Chi Hospital, Taichung, Taiwan.
² Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.
³ Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
⁴ Rheumatology and Immunology Center, Translational Medicine Laboratory, Taichung, Taiwan.
⁵ Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁶ Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.

Abstract

Rheumatoid arthritis (RA) is characterized by persistent synovitis and joint/bone destruction. There is an unmet need to predict the therapeutic response to disease-modifying anti-rheumatic drugs (DMARDs) and achieve a treat-to-target goal. Musculoskeletal ultrasound (MSUS) is widely used to identify structural change and assess therapeutic response in RA. This review aims to summarize the available evidence regarding the clinical application of MSUS in evaluating disease activity and predicting therapeutic responses to DMARDs. We searched the MEDLINE database using the PubMed interface and reviewed English-language literature from 2000 to 2022. This review focuses on the updated role of MSUS in assessing disease activity and predicting therapeutic responses to DMARDs in RA patients. MSUS is now widely applied to identify articular structural change and assess the disease activity of RA. Combined use of gray scale and power Doppler MSUS is also superior to clinical assessment and laboratory examination in evaluating disease activity of RA. With portable use, good viability, and high sensitivity to articular inflammation, MSUS would be useful in assessing therapeutic response to biologic/targeted synthetic DMARDs (b/tsDMARDs) in RA patients. Given MSUS could also detect subclinical inflammation in a substantial proportion of RA patients with clinical remission, it is recommended to assess b/tsDMARDs-treated RA patients who have achieved low disease activity or remission. Although substantial literature data have revealed clinical utility of MSUS for monitoring disease activity and evaluating therapeutic response in RA patients, the evidence regarding its predictive value for the effectiveness of b/tsDMARDs is limited.

Keywords: Disease activity; disease-modifying antirheumatic drugs; rheumatoid arthritis; therapeutic response; ultrasound.

Publication types

Review