Background: Treatment of rheumatoid arthritis (RA) should aim at full remission. Ultrasonography (US) might have an added value to clinical examination in assessing disease activity of RA. In this study we evaluated the ultrasound response, next to clinical and laboratory response, in RA patients treated with tofacitinib (TOF).Methods: In this observational multicenter study, patients received TOF 5 mg twice daily, with or without the contemporary use of methotrexate or other conventional DMARD, for 24 weeks. All patients underwent clinical, laboratory and US examinations of 40 sites among joints and tendons. Sonographers were blinded to clinical and laboratory parameters. Data were assessed at baseline, week 2, 4, 8, 12 and 24. For each patient we used two US joint scores (Gray Scale –GS–and power Doppler –PD– score), a 0–3 semi-quantitative scale for each joint and the EULAR-OMERACT US scoring system (combined GS and PD graded from 0 to 3). Besides, we calculated a tenosynovitis scores (GS and PD) according to the OMERACT score.Results: Fifty-two RA patients completed the 6 months period study: mean disease duration 9.97 ± 8.75 years, baseline DAS28-CRP 4.9 ± 1.2, HAQ 1.4 ± 0.7, C-reactive protein (CRP 2.25 ± 3.11 mg/dl). Baseline joint (GS, PD and combined-US) and tendon US scores (GS and PD) were 23.5 ± 18.4, 22.7 ± 19.3, 25.7 ± 20.6, 10.5 ± 11.4 and 11.0 ± 12.0, respectively. US joint and tendon scores significantly reduced as early as T1 (week 2) examination as well as at week 4, 12 and 24, as compared to baseline values (p < 0.001 for all comparisons). Improvement of joint US scores (GS, PD and US-combined) correlated at T4 examination, with the reduction of serum CRP levels (rho 0.418, p = 0.036, rho 0.495, p = 0.004 and rho 0.454, p = 0.009, respectively). We did not find any correlation between the variations of DAS28-CRP and any US scores at any visits.Conclusion: These results provide evidence that TOF treatment leads to early (2 weeks) and persistent reduction of US signs of inflammation both at tendon and joint level comparable to clinical improvement.

Objective: To evaluate the diagnostic accuracy, reproducibility, and acquisition time of focused bilateral frontal‐branch ultrasonography based on intima‐media thickness (IMT) in suspected giant cell arteritis (GCA). Methods: In this prospective single‐center study, 171 patients underwent color Doppler ultrasonography of the temporal and large arteries and ultrasonography‐guided temporal artery biopsy. Bilateral mean frontal‐branch IMT was evaluated against the expert diagnosis established at six months. Diagnostic performance was assessed using ROC analysis and multivariable logistic regression. Reproducibility was assessed in 100 randomly selected images. Results: GCA was diagnosed in 107 patients, including 96 biopsy‐positive cases. Mean frontal‐branch IMT had the highest observed area under the curve among the temporal artery segments (0.87). At the 0.28‐mm cutoff, sensitivity was 71%, specificity 94%, LR+ 11.4, and LR− 0.31. Frontal IMT ≥ 0.28 mm was the strongest independent predictor of GCA (odds ratio 43.0). At a cutoff of ≥3, the exploratory PAMELA (Performance Analysis of a Monosegmental Ultrasonographic Evaluation of the Frontal‐Branch of the Superficial Temporal Artery in Giant Cell Arteritis) score had a sensitivity of 74.8% and specificity of 93.7%. Focused bilateral frontal‐branch assessment required 1.07 ± 0.24 minutes versus 7.62 ± 1.11 minutes for the complete temporal artery protocol. Intraobserver and interobserver intraclass correlation coefficients were 0.96 and 0.93. Conclusion: Focused bilateral frontal‐branch ultrasonography provides a highly specific, reproducible, and time‐efficient initial cranial assessment in suspected GCA. However, the 0.28‐mm cutoff and PAMELA score require external validation, and the remaining temporal and large‐vessel territories should be examined when frontal findings are negative or equivocal.

Entrectinib treatment does not result in body weight loss.

Entrectinib treatment does not result in body weight loss.

Pathological studies have demonstrated that the adventitial layer is markedly thickened in Takayasu (TAK) as compared to large vessel giant cell arteritis (LV-GCA). An ultrasound (US) examination of the arterial vessels allows the determination of intima media thickness (IMT) and of adventitial layer thickness (extra media thickness (EMT)). No previous study has evaluated if there are differences in EMT thickness between TAK and LV-GCA. In this cross-sectional retrospective study of stored ultrasound (US) imaging, we have compared common carotid artery (CCA) EMT and IMT in a series of consecutive TAK and LV-GCA patients. US examination CCA IMT and EMT were significantly higher in TAK as compared to LV-GCA. With ROC curve analysis, we have found that an EMT > 0.76 mm has high sensitivity and specificity for TAK CCA examination. The percentage of CCA at EMT > 0.76 mm and the total arterial wall thickening were significantly higher in TAK group examinations. EMT thickness correlated with disease duration and IMT in the TAK group, as well as with the IMT and ESR values in the LV-GCA group. Upon multivariate logistic regression analysis, factors independently associated with TAK CCA were EMT > 0.76 mm and age. No significant variation in IMT and EMT could be demonstrated in subsequent US CCA examinations.