Conventional versus ultrasound treat to target: no difference in magnetic resonance imaging inflammation or joint damage over 2 years in early rheumatoid arthritis

Rheumatology (Oxford). 2020 Sep 1;59(9):2550-2555. doi: 10.1093/rheumatology/kez674.


Objective: To investigate whether an ultrasound-guided treat-to-target strategy for early RA would lead to reduced MRI inflammation or less structural damage progression compared with a conventional treat-to-target strategy.

Methods: A total of 230 DMARD-naïve early RA patients were randomized to an ultrasound tight control strategy targeting DAS <1.6, no swollen joints and no power Doppler signal in any joint or a conventional strategy targeting DAS <1.6 and no swollen joints. Patients in both arms were treated according to the same DMARD escalation strategy. MRI of the dominant hand was performed at six time points over 2 years and scored according to the OMERACT RA MRI scoring system. A total of 218 patients had baseline and one or more follow-up MRIs and were included in the analysis. The mean MRI score change from baseline to each follow-up and the 2 year risk for erosive progression were compared between arms.

Results: MRI bone marrow oedema, synovitis and tenosynovitis improved over the first year and was sustained during the second year of follow-up, with no statistically significant differences between the ultrasound and the conventional arms at any time point. The 2 year risk for progression of MRI erosions was similar in both treatment arms: ultrasound arm 39%, conventional arm 33% [relative risk 1.16 (95% CI 0.81, 1.66), P = 0.40].

Conclusion: Incorporating ultrasound information in treatment decisions did not lead to reduced MRI inflammation or less structural damage compared with a conventional treatment strategy. The findings support that systematic use of ultrasound does not provide a benefit in the follow-up of patients with early RA.

Trial registration number:,, NCT01205854.

Keywords: clinical trials and methods; diagnostic imaging; magnetic resonance imaging; outcome measures; rheumatoid arthritis; ultrasonography.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid* / diagnosis
  • Arthritis, Rheumatoid* / drug therapy
  • Arthritis, Rheumatoid* / physiopathology
  • Disease Progression
  • Female
  • Foot Joints* / diagnostic imaging
  • Foot Joints* / pathology
  • Functional Status
  • Hand Joints* / diagnostic imaging
  • Hand Joints* / pathology
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Radiography / methods
  • Remission Induction / methods
  • Synovitis* / diagnosis
  • Synovitis* / etiology
  • Tenosynovitis* / diagnosis
  • Tenosynovitis* / etiology
  • Ultrasonography, Doppler / methods*


  • Antirheumatic Agents

Associated data