What question did this study set out to answer?

The study aims to evaluate how musculoskeletal ultrasound influences the decision to switch therapies in patients with established rheumatoid arthritis.

March 26, 2026Open Access

Musculoskeletal Ultrasound and the Decision to Switch Therapy in Patients With Established Rheumatoid Arthritis

Puntos clave

The study aims to evaluate how musculoskeletal ultrasound influences the decision to switch therapies in patients with established rheumatoid arthritis.
Enrolled 32 patients with established rheumatoid arthritis.
Obtained clinical disease activity scores (CDAI, DAS28) and ultrasound scores (PDUS/GSUS).
Used Pearson correlation coefficients to examine relationships between ultrasound and clinical scores.
Compared demographics and outcomes between therapy switchers and non-switchers.
59% of the patients switched therapy based on ultrasound and disease activity scores.
Higher DAS28 and PDUS scores were observed in switchers compared to non-switchers, though not statistically significant.
80% of patients with high DAS28 and PDUS scores switched therapy, compared to only 25% with low scores.
60% of patients in discordant groups (high DAS28/low PDUS and vice versa) switched therapy.

Resumen

Introduction Musculoskeletal ultrasound (MSUS) with power Doppler ultrasound (PDUS) or gray-scale ultrasound (GSUS) has been increasingly used to detect active synovitis. This study evaluated PDUS/GSUS scores and clinical disease activity scores in patients with established rheumatoid arthritis (RA) whose rheumatologist was considering a therapy switch. Methods Thirty-two patients with RA were enrolled. Clinical Disease Activity Index (CDAI), Disease Activity Score-28 (DAS28), and PDUS/GSUS scores were obtained. Pearson correlation coefficients were used to evaluate the relationship of PDUS-24 and GSUS-24 with clinical composite measures. Demographics, disease activity measures, MSUS scores, and patient-reported outcomes were examined between switchers and non-switchers. Results Of the 32 patients enrolled, 59% (n=19) switched therapy. Switchers had numerically higher DAS28, CDAI, CRP/ESR, and PDUS/GSUS scores, but these metrics were not statistically significantly different from those of non-switchers. Among patients with concordant findings, 80% (n=8/10) of those with DAS28 ≥3.2 and high PDUS (>5) switched therapy, whereas only 25% (n=1/4) of patients with DAS28 <3.2 and low PDUS (≤5) did so. In the discordant group, therapy was switched in 60% of patients with high DAS28/low PDUS (n=6/10) and 60% of those with low DAS28/high PDUS (n=3/5). Physician global assessment and physician-reported RA flare were higher among therapy switchers (t(29) = -2.96, p=0.006; and Fisher’s exact p=0.03, respectively). Non-switchers were more satisfied with their treatment compared to switchers (8.8 vs 5.3, t(30) = 4.42, p<0.001). Conclusion Among patients with established RA, disease-modifying antirheumatic drug (DMARD) switchers had numerically higher CDAI, DAS28, and PDUS/GSUS scores compared with non-switchers. Eighty percent of patients with both increased DAS28 and PDUS switched therapy, compared with 60% of those with discordant findings, including high DAS28/low PDUS and vice versa. The PDUS/DAS28-discordant population faces inherently difficult therapeutic decisions and highlights the lack of guidance for physicians and patients.

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