Rheumatoid arthritis

Ultrasound use in RA treatment gathers momentum


A growing number of Australian rheumatologists are embracing the use of Doppler ultrasound (DUS) imaging technology in the management of rheumatoid arthritis patients, says a Sydney rheumatologist spearheading the push to make it more common practice.

Associate Professor Fred Joshua said he expected about 25% of all rheumatologists would be trained to use DUS in the clinical setting by March next year. He sees DUS as the next frontier in the diagnosis of RA.

“It’s very exciting to see the interest in upskilling and training, it has really picked up in the last three years,” he told the limbic. “I think it’s also really good to show the community that we’re not just playing at it.”

And it seems rheumatologists are the only ones embracing the technology – research shows that the use of DUS improves RA patients’ attitudes towards treatment adherence, with nearly all patients who underwent DUS assessment (94%) saying that discussing DUS with their rheumatologist helped them take medications according to their rheumatologists’ directions.

In addition, almost three quarters (74%) of patients stated that discussing DUS with their rheumatologist helped them better understand their disease.

The study was documented in a presentation at the American College of Rheumatology’s annual meeting late last year.

Professor Joshua is the lead researcher of the study, Defining Rheumatoid Arthritis Progression using Doppler Ultrasound in Clinical Practice (DEDUCE) which set out to assess the current use of DUS in Australian patients with RA.

“Doppler ultrasound is a relatively inexpensive, non-invasive technique for direct visualisation and assessment of joint inflammation and structural damage in patients with RA,” he said.

The study revealed clear barriers to the uptake of DUS use amongst rheumatologists, despite its ability to increase treatment adherence amongst patients.

“The study indicated that cost, inconvenience for patients, and concern regarding usefulness and practicality were cited as barriers to the routine use of DUS imaging in clinical practice,” Professor Joshua said.

“The DEDUCE study clearly suggests that it positively impacts patients’ understanding of their disease, empowering them to correctly take their medications, which will help encourage rheumatologists to utilise this imaging tool.”

In response to these perceived barriers, research-based biopharmaceutical company AbbVie teamed up with Professor Joshua to launch an innovative program called IMAGINE to help increase the number of rheumatologists using of ultrasound in rheumatology and drive treat to target (T2T) principles.

The program trains and accredits Steering Committee-selected Australian rheumatologists through the Australian Society of Ultrasound in Medicine.

Professor Joshua told the limbic that about 40% of rheumatologists were now using DUS in some form, either with their own machines in-rooms, or outsourcing to radiology services.

He said the technology was non-invasive and highly effective in showing synovitis, confirming diagnosis, and monitoring for inflammatory activity and residual disease. And this information can be relayed to the patient in a highly visual manner.

This was particularly useful when a patient may feel no effects from pain and inflammation and be inclined to stop taking medication. A DUS that can detect inflammation will help the specialist show the patient why medication adherence is necessary.

“There’s been a fundamental change in attitudes because of new medications and being able to measure progress and show it visually is very helpful when you are having these discussions with patients,” he said. “A good way to consider it is as an adjunctive tool.”

He cautioned that DUS was not a replacement for all imaging, and the gold standard remains the MRI, which is more invasive but provides far more detailed information.

“I use the DUS when I need to make a clear clinical decision, when I am not sure of how bad the joints are, and I want to see what is needed to the appropriate therapeutic response.”

Meanwhile, he believes there are many other musculoskeletal disorders that could use DUS to great benefit, including osteoarthritis, vasculitis and even gout.

“It’s a very good, non-invasive tool – we just need a lot more research now,” he said.

 

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