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Title: Qualification of ultrasonography as a biomarker of prognosis and response to treatment in early rheumatoid arthritis
Author: Sreerangaiah, Dee
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2012
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Objectives: to assess the value of quantitative vascular imaging by power Doppler ultrasound (PDUS) as a tool that can be used to stratify patient risk of joint damage in early seropositive RA while still biologic-naive but on synthetic DMARD treatment. Methods: 85 patients with seropositive RA <3 years duration, had clinical, laboratory and imaging assessments at 0, 6 and 12 months. Imaging assessments consisted of radiographs of hands and feet, 2 dimensional high frequency and PDUS imaging of 10 metacarpophalangeal joints (MCPJs) which were scored for erosions and vascularity, and 3 dimensional PDUS of MCPJs and wrists which were scored for vascularity. Results: Severe deterioration on radiographs and ultrasonography was seen in 45% and 28% of patients respectively. 3D PD volume and 2D vascularity scores were the most useful ultrasound predictors of deterioration. These variables were modelled in 2 equations which estimate structural damage over 12 months. The equations had a sensitivity of 63.2% and specificity of 80.9% for predicting structural damage on x-ray, and a sensitivity of 54.2% and specificity of 96.7% for predicting structural damage on ultrasound. Conclusions: In seropositive early RA, quantitative vascular imaging by PDUS has clinical utility in predicting which patients would derive benefit from early use of biologics therapy.
Supervisor: Taylor, Peter; Abraham, Sonya Sponsor: Medical Research Council
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available