Sensitivity of Echography in Arthritis
Sensitivity of Echography in Arthritis
It has been reported recently that the detection of synovitis by ultrasonography was more
 sensitive than clinical examination (Wakefield et al. Ann Rheum Dis).

 An OMERACT and EULAR working party recently produced guidelines on the best way to record and
 score quantitatively synovitis of the small joints of the hands and feet (Wakefield R,
 D'Agostino MA).

 It has also been presumed recently that ultrasonography was more sensitive to changes than
 clinical examination after anti-TNF treatment (Ref. Taylor et al). If this better sensitivity
 to change were to be confirmed, ultrasonography would be preferred to clinical examination in
 studies evaluating new treatments.

 In everyday practice, better intrinsic validity of the evaluation of synovitis by
 ultrasonography would lead to widespread use of this technique in the diagnosis and treatment
 of rheumatoid arthritis patients.

 Objective of this study is to compare the sensitivity to change in synovitis score according
 to the monitoring method used (clinical examination versus ultrasonography).
This is a multicenter, (10 French centers and 1 Belgian center), prospective (4-month
 patients' follow-up) interventional study in 120 patients with rheumatoid arthritis
 justifying anti-TNF treatment.

 The overall duration of the study will be 8 months composed of a 4-month inclusion period and
 a 4-month follow-up period for each patient. Moreover, X-ray evaluations of hands and feet
 will be performed 2 years from the beginning of the study in order to assess the changes in
 structural damage.

 During the patients' participation, 6 visits are planned: an inclusion visit then, a
 follow-up visit at 1, 2 and 3 months from the inclusion visit, and a final evaluation visit
 at 4 months from the inclusion visit. At each visit, synovitis will be evaluated using both
 methods: clinical examination and ultrasonography. For a same patient, clinical evaluation of
 synovitis will have to be performed - during the entire study - by the same rheumatologist
 and the ultrasonographic evaluation will have to be performed by the same ultrasonographist
 (different from the rheumatologist) and always using the same ultrasonograph.

 Finally, patients will be performed anterior X-rays of hands and feet two years from the
 beginning of the study whatever the ongoing RA treatment.
Inclusion Criteria:

 -  Patients with rheumatoid arthritis meeting ACR criteria.

 -  Justifying anti-TNF alpha treatment (switch or first administration).

 -  To have at least 6 synovitis at the clinical examination necessary for the DAS
 evaluation

 -  To accept to participate in this study (informed consent signed).

 Exclusion Criteria:

 -  Minor patients.

 -  Pregnancy.

 -  Breastfeeding.