Ultrasound Synovitis Offers Potential Treatment Strategy for Patients with Rheumatoid Arthritis and Fibromyalgia

Ultrasound Synovitis Offers Potential Treatment Strategy for Patients with Rheumatoid Arthritis and Fibromyalgia

pharmacyFindings from a recent study published in the journal PLoS One found that ultrasound synovitis (US) scores are not affected by Fibromyalgia in patients with Rheumatoid Arthritis, with researchers indicating that US may be a potential treatment strategy for these patients.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by erosive synovitis, responsible for bone and cartilage damage. The condition is usually treated with disease modifying antirheumatic drugs (DMARDs) to prevent joint destruction.

Fibromyalgia (FM) is a chronic pain condition accompanied by somatic symptoms such as fatigue and sleep disorders. FM is present in up to 20% of RA patients and may increase subjective components of disease activity indexes, misleading treatment decision. FM-induced overestimation of RA activity may cause overtreatment as DMARDs are changed to achieve the target and undertreatment as physicians aware of FM impact on clinical scores may not change DMARD when truly necessary.

Ultrasound (US) is an objective synovitis assessment tool that is able to predict joint destruction. Gray-scale (GSUS) and power Doppler ultrasound (PDUS) are capable of measuring synovial proliferation and vascularization. The validated 7-joint score (US7) combines each joint score for synovial proliferation (GS-US7) and vascularization (PD-US7).

In their study titled “Is ultrasound a better target than clinical disease activity scores in rheumatoid arthritis with fibromyalgia? A case-control study,” Rafael Mendonca da Silva Chakr from the Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul in Brazil and colleagues aimed to examine the potential correlations among gray-scale seven-joint ultrasound score (GS-US7), power Doppler seven-joint ultrasound score (PD-US7), disease activity score-28 joints (DAS28), simplified disease activity index (SDAI) and clinical disease activity index (CDAI) in patients with and without fibromyalgia (FM).

In a total of 247 RA patients that were screened to participate in the study, 72 women were included. These women had RA symptoms for 13 years and FM symptoms for 6 years. The researchers analyzed Disease-modifying antirheumatic drugs, non-steroidal anti-inflammatory drugs and prednisone use, and found that objective activity parameters were not different between groups. Patients with Rheumatoid Arthritis and Fibromyalgia had greater DAS28, SDAI and CDAI but similar GS-US7 and PD-US7. GS-US7 correlated with DAS28, SDAI and CDAI in patients with and without Fibromyalgia while PD-US7 was found to be correlated with clinical scores only in those patients without Fibromyalgia.

Based on the results ,the researchers concluded that Fibromyalgia does not affect ultrasound synovitis scores in patients with Rheumatoid Arthritis. PD-US7 performed better than GS-US7 in long-standing RA patients with DAS28, SDAI or CDAI allegedly overestimated due to FM. Based on the notion that sonographic synovitis is able to predict erosion better than swollen joint count, C-reactive protein and erythrocyte sedimentation rate, US should be considered as a potential treatment target in patients with RA with FM.