Grade and location of power Doppler are predictive of damage progression in rheumatoid arthritis patients in clinical remission by anti-tumour necrosis factor α

Rheumatology (Oxford). 2017 Aug 1;56(8):1320-1325. doi: 10.1093/rheumatology/kex084.


Objectives: To investigate power Doppler (PD) signal, grade and location and their association with radiographic progression in RA patients in remission.

Methods: A prospective observational study was conducted in 125 consecutive RA patients in stable 28-joint DAS (DAS28) remission (⩾6 months) achieved on anti-TNF-α. At baseline, patients in stable remission underwent radiographic and US examination of the wrists and MCP, PIP and MTP joints. Semi-quantitative PD scoring (0-3) was recorded. We scored PD according to two locations: capsular or within synovial tissue without bone contact (location 1) and with bone contact or penetrating bone cortex (location 2). Radiographic progression was evaluated at the 1 year follow-up and defined as a change in van der Heijde-modified total Sharp score >0. Risk ratios (RRs) of radiographic progression according to presence, grade and location of PD were calculated.

Results: Four patients were excluded because of missing data. At baseline, 59/121 (48.7%) patients had a PD signal in one or more joints. PD location 2 was found in 74.6% patients (44/59). At the 1 year follow-up, 17/121 patients experienced radiographic progression: all had PD signal in one or more joints at baseline (RR 2.47, P < 0.0001). Radiographic progression was associated with the following baseline US features: PD grade 2 (RR 4.58, P < 0.01), PD grade 3 (RR 3.49, P < 0.05), total PD score ⩾2 (sum of all PD scores) (RR 3.19, P < 0.0001) and PD location 2 (RR 3.49, P < 0.0001).

Conclusion: Higher PD grades and PD in contact with/or penetrating bone are associated with radiographic progression in patients in DAS28 remission.

Keywords: agents; anti-TNF-α; erosion; power Doppler; power Doppler grade; power Doppler location; radiographic progression; remission; rheumatoid arthritis; synovitis; ultrasound.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / diagnostic imaging*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / pathology
  • Disease Progression*
  • Female
  • Follow-Up Studies
  • Hand Joints / diagnostic imaging
  • Hand Joints / pathology
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Radiography / methods
  • Remission Induction / methods
  • Severity of Illness Index*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Ultrasonography, Doppler / methods
  • Wrist Joint / diagnostic imaging
  • Wrist Joint / pathology


  • Antirheumatic Agents
  • Tumor Necrosis Factor-alpha