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Positive rate and prognostic significance of the superb microvascular imaging signal in joints of rheumatoid arthritis patients in remission with normal C-reactive protein levels and erythrocyte sedimentation rates

  • Original Article–Orthopedics
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Abstract

Purpose

This study aimed to evaluate the positive rate and prognostic significance of superb microvascular imaging (SMI) in rheumatoid arthritis (RA) patients in remission with normal C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR).

Methods

The study enrolled 112 RA patients, and ultrasound (US) assessment was performed on 28 joints of each patient.

Results

The SMI signal-positive rates for each joint were: metacarpophalangeal (MCP) joints: 20.5%, wrist joints: 43.8%, metatarsophalangeal (MTP) joints: 17.0%, and other foot joints: 25.0%. Investigation of the prognostic significance of the SMI signal in each joint revealed that only in the MTP joints was the total score of the SMI signal in the patients with relapse significantly higher than that in the patients with remission (P = 0.01). Comparison of the receiver operating characteristics curves for predicting relapse showed that the area under the curve (AUC) of the MTP joints was the highest (AUC = 0.66) of the investigated joints. The optimal threshold for the total MTP SMI score was 1 (accuracy = 83.3%). Positive/negative data of the SMI signal in the MTP joints were not significantly associated with the values of conventional disease activity markers.

Conclusion

In RA patients in remission with normal CRP and ESR levels, the percentage of positive SMI signal was highest in the wrist joints. However, the accuracy of the SMI signal for predicting relapse was greatest for the MTP joints, suggesting that US assessment of the MTP joints by SMI is useful for predicting relapse in these patients.

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Abbreviations

SMI:

Superb microvascular imaging

MCP:

Metacarpophalangeal

MTP:

Metatarsophalangeal

ROC:

Receiver operating characteristics

AUC:

Area under the curve

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Acknowledgements

This work was supported by JSPS KAKENHI (18K12103).

Author information

Authors and Affiliations

  1. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Hidemasa Matsuo, Risako Yukimatsu, Akari Imamura, Madoka Shimizu, Maiko Inagaki, Yuko Tsuji & Yasutomo Fujii

  2. Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Yuya Tabuchi, Shuichiro Nakabo, Hideaki Tsuji, Toshiki Nakajima & Akio Morinobu

  3. Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Motomu Hashimoto & Hiromu Ito

  4. Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Hiromu Ito

Authors
  1. Hidemasa Matsuo
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  2. Yuya Tabuchi
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  14. Yasutomo Fujii
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Corresponding author

Correspondence to Hidemasa Matsuo.

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Conflict of interest

Y. Tabuchi receives instructor fees from Asahi Kasei Pharma, Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku, and speaker fees from AbbVie, Chugai Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma. M.H. and H.I. work in a department that received financial support from Nagahama City, Toyooka City, and five pharmaceutical companies (Mitsubishi Tanabe Pharma, Chugai Pharmaceutical, UCB Japan, Ayumi, and Asahi Kasei Pharma). M.H. receives research grants and/or speaker fees from Bristol-Myers, Eisai, Eli Lilly, and Mitsubishi Tanabe Pharma. H.I. receives research grants from Bristol-Myers, Eisai, Mochida, and Taisho. The KURAMA cohort study is supported by a grant from Daiichi-Sankyo. The present study was an investigator-initiated study. These companies played no role in study design, data collection or analysis, writing of the manuscript, or the decision to submit for publication. H.M., R.Y., A.I., M.S., M.I., Y. Tsuji, S.N., H.T,. T.N., A.M., and Y.F. declare no competing financial interests.

Ethical statements

This study was conducted in accordance with the principles set down in the Declaration of Helsinki and was approved by the ethics committee of Kyoto University (R0357). All patients provided written informed consent.

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Matsuo, H., Tabuchi, Y., Yukimatsu, R. et al. Positive rate and prognostic significance of the superb microvascular imaging signal in joints of rheumatoid arthritis patients in remission with normal C-reactive protein levels and erythrocyte sedimentation rates. J Med Ultrasonics 48, 353–359 (2021). https://doi.org/10.1007/s10396-021-01102-5

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  • DOI: https://doi.org/10.1007/s10396-021-01102-5

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