Ultrasound-detected synovitis, tenosynovitis may aid treatment decisions in SLE

Among systemic lupus erythematosus (SLE) patients with musculoskeletal symptoms, those who have positive ultrasound appear to show better response to therapy, a study reports.

The study included 133 SLE patients with physician-diagnosed inflammatory joint pain, all of whom received intramuscular methylprednisolone 120 mg once. Clinical assessments, patient-reported outcomes, and bilateral hands/wrist ultrasound were obtained at baseline and weeks 2 and 6.

There were 78 patients who had a positive ultrasound (Grey-scale ≥2 and/or Power-Doppler ≥1), among whom 53 (68 percent) had ≥1 swollen joint. Meanwhile, of the 133 patients, 66 had ≥1 swollen joint out, and 20 percent of them had a negative ultrasound. Patients with a positive ultrasound were more likely to have joint swelling, symmetrical small joint distribution, and serology.

The primary endpoint of early morning stiffness visual analogue scale (EMS-VAS) at 2 weeks was not met. Baseline-adjusted EMS-VAS did not differ in the positive and negative ultrasound groups in the full analysis set (n=133; –7.7 mm, 95 percent confidence interval [CI], –19.0 to 3.5; p=0.178).

Following exclusion of 32 patients with fibromyalgia, treatment response was shown to be much more favourable in patients with positive ultrasound at baseline (baseline-adjusted EMS-VAS, 12.1 mm, 95 percent CI, –22.2 to –0.1 mm; p= 0.049). This difference was greater when adjusted for treatment (–12.8 mm (95 percent CI, –22 to –3; p=0.007).

British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) responses were higher in ultrasound-positive patients.

The present data indicate that imaging-detected synovitis/tenosynovitis may be considered to decide on therapy and enrich clinical trials.