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Ultrasound is more reliable than inflammatory parameters to evaluate disease activity in patients with RA receiving tocilizumab therapy
  1. Wen-Chan Chiu,
  2. Han-Ming Lai,
  3. Chi-Hua Ko,
  4. Jia-Feng Chen,
  5. Chung-Yuan Hsu,
  6. Ying-Chou Chen
  1. Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
  1. Correspondence to Dr Ying-Chou Chen, Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833,Taiwan; r820713{at}


The target of treatment for rheumatoid arthritis (RA) is to keep low disease activity or remission. Tocilizumab can fully inhibit interleukin-6 and C reactive protein (CRP) production. The goal of the study is to search whether tocilizumab treatment compared with adalimumab treatment had the similar effect on sonography and inflammatory parameters in patients with RA. We compared ultrasound scores and inflammatory parameters between patients with RA receiving tocilizumab therapy and those receiving adalimumab therapy. Power Doppler (PD) ultrasound and grayscale synovial hypertrophy on bilateral radiocarpal joints were performed. Inflammatory mediators and ultrasound scores were compared by independent t-test between the adalimumab and tocilizumab groups. 65 patients with RA (32 tocilizumab and 33 adalimumab) were included. Between the two groups, there were no significant differences in age, gender, rheumatoid factors and anticyclic citrullinated peptide antibody. Following biological therapy, the ultrasound score was 2.33 in the tocilizumab group and 2.08 in the adalimumab group (p=0.570), while the erythrocyte sedimentation rate, CRP and Disease Activity Score in 28 joints (DAS28) were lower in the tocilizumab group. So ultrasound scores between the two groups were not significantly different, but the laboratory parameters and DAS28 were lower in the tocilizumab group than in the adalimumab group. Hence, to assess disease activity cannot be based only on clinical evaluations, so we suggest PD ultrasound to be used for all patients on tocilizumab therapy and reflect the true disease activity in these patients.

  • ultrasound
  • rheumatoid arthritis
  • tocilizumab
  • effect

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  • Contributors W-CC designed and performed the research. J-FC performed the ultrasonography. C-HK, C-YH and H-ML analyzed the data. C-HK provided the rheumatoid arthritis care. Y-CC wrote the final paper. W-CC and H-ML had the same contribution.

  • Funding This study was supported by Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung (grant CMRPG8D1061).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This prospective cohort study was approved by CMRP Kaohsiung Chang Gung Memorial Hospital Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at This study was presented as a poster presentation at the American College of Rheumatology Annual Meeting in Washington, DC (November 11–16, 2016).

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