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Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial

BMJ (Online), 2016-08, Vol.354, p.i4205-i4205 [Peer Reviewed Journal]

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. ;Copyright BMJ Publishing Group LTD Aug 16, 2016 ;info:eu-repo/semantics/openAccess ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2016 BMJ ;ISSN: 1756-1833 ;ISSN: 0959-535X ;ISSN: 0959-8146 ;ISSN: 0959-8138 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.i4205 ;PMID: 27530741

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Title:
Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial
Author: Haavardsholm, Espen A ; Aga, Anna-Birgitte ; Olsen, Inge Christoffer ; Lillegraven, Siri ; Hammer, Hilde B ; Uhlig, Till ; Fremstad, Hallvard ; Madland, Tor Magne ; Lexberg, Åse Stavland ; Haukeland, Hilde ; Rødevand, Erik ; Høili, Christian ; Stray, Hilde ; Noraas, Anne ; Hansen, Inger Johanne Widding ; Bakland, Gunnstein ; Nordberg, Lena Bugge ; van der Heijde, Désirée ; Kvien, Tore K
Subjects: Activities of Daily Living ; Antirheumatic Agents - therapeutic use ; Arthritis, Rheumatoid - diagnostic imaging ; Arthritis, Rheumatoid - drug therapy ; Clinical medical disciplines: 750 ; Clinical medicine ; Disease ; Disease Progression ; Humans ; Inflammation ; Joints - diagnostic imaging ; Klinisk medisinske fag: 750 ; Male ; Medical disciplines: 700 ; Medical research ; Medisinske Fag: 700 ; Middle Aged ; Patients ; Quality of Life ; Remission (Medicine) ; Rheumatoid arthritis ; Rheumatology ; Treatment Outcome ; Ultrasonic imaging ; Ultrasonography - methods ; VDP
Is Part Of: BMJ (Online), 2016-08, Vol.354, p.i4205-i4205
Description: Objective To determine whether a treatment strategy based on structured ultrasound assessment would lead to improved outcomes in rheumatoid arthritis, compared with a conventional strategy.Design Multicentre, open label, two arm, parallel group, randomised controlled strategy trial.Setting Ten rheumatology departments and one specialist centre in Norway, from September 2010 to September 2015.Participants 238 patients were recruited between September 2010 and April 2013, of which 230 (141 (61%) female) received the allocated intervention and were analysed for the primary outcome. The main inclusion criteria were age 18-75 years, fulfilment of the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis, disease modifying anti-rheumatic drug naivety with indication for disease modifying drug therapy, and time from first patient reported swollen joint less than two years. Patients with abnormal kidney or liver function or major comorbidities were excluded.Interventions 122 patients were randomised to an ultrasound tight control strategy targeting clinical and imaging remission, and 116 patients were randomised to a conventional tight control strategy targeting clinical remission. Patients in both arms were treated according to the same disease modifying anti-rheumatic drug escalation strategy, with 13 visits over two years.Main outcome measures The primary endpoint was the proportion of patients with a combination between 16 and 24 months of clinical remission, no swollen joints, and non-progression of radiographic joint damage. Secondary outcomes included measures of disease activity, radiographic progression, functioning, quality of life, and adverse events. All participants who attended at least one follow-up visit were included in the full analysis set.Results 26 (22%) of the 118 analysed patients in the ultrasound tight control arm and 21 (19%) of the 112 analysed patients in the clinical tight control arm reached the primary endpoint (mean difference 3.3%, 95% confidence interval −7.1% to 13.7%). Secondary endpoints (disease activity, physical function, and joint damage) were similar between the two groups. Six (5%) patients in the ultrasound tight control arm and seven (6%) patients in the conventional arm had serious adverse events.Conclusions The systematic use of ultrasound in the follow-up of patients with early rheumatoid arthritis treated according to current recommendations is not justified on the basis of the ARCTIC results. The findings highlight the need for randomised trials assessing the clinical application of medical technology.Trial registration Clinical trials NCT01205854.
Publisher: England: BMJ Publishing Group LTD
Language: English
Identifier: ISSN: 1756-1833
ISSN: 0959-535X
ISSN: 0959-8146
ISSN: 0959-8138
EISSN: 1756-1833
DOI: 10.1136/bmj.i4205
PMID: 27530741
Source: BMJ Open Access Journals
MEDLINE
NORA Norwegian Open Research Archives
ProQuest Central

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Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial

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