Abstract
Objective This study aimed to investigate the clinical and ultrasonographic factors associated with radiographic progression at 1 year after treatment initiation in patients with treatment-naïve rheumatoid arthritis (RA).
Methods We consecutively enrolled treatment-naïve patients with RA who presented to our hospital between January 2018 and December 2023. Clinical disease activity indices, musculoskeletal ultrasound (MSUS) findings of 22 joints in the hands and wrists, and radiographic findings were evaluated at baseline and at the 1-year follow-up. Data were analyzed retrospectively.
Results A total of 265 patients were included. The median duration from symptom onset to treatment initiation was 3.6 months. Baseline disease activity was moderate, with mean Simplified Disease Activity Index and Clinical Disease Activity Index values of 21.2 and 19.5, respectively. All patients initiated treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs), and treatment was managed according to a treat-to-target strategy. At 1 year after treatment initiation, 110 patients (41.5%) received biologic or targeted synthetic DMARDs. Concurrently, 215 patients (81.1%) maintained radiographic remission of the hands and wrists, defined as a change in the modified total Sharp score (mTSS) of the hand and wrist (Δhand/wrist mTSS) of ≤ 0.5/year. Multivariable logistic regression analysis showed no significant association between clinical factors, including disease activity indices, and radiographic progression. The presence of power Doppler (PD) signals penetrating into bone erosions was the only independent factor associated with lower odds of maintained structural remission (odds ratio 0.20; 95% CI 0.09-0.46; P < 0.001).
Conclusion In treatment-naïve patients with RA, the presence of intraerosive PD signals on MSUS was associated with radiographic progression at 1 year after treatment initiation.
