Joints with synovial hypertrophy (SH) without Doppler activity improve during treatment, independent of the grade, according to a recent study. Thus, SH without Doppler activity is not a sign of inactive disease. In order to explore to what extent SH in joints without Doppler activity is a sign of active disease, researchers investigated the sensitivity to change of SH without Doppler activity during biological disease-modifying antirheumatic drug (bDMARD) treatment in patients with rheumatoid arthritis (RA). 151 patients initiating or switching bDMARD treatment had ultrasound (US) performed on 36 joints at baseline, and at 3 and 6 months. Changes in SH in joints without Doppler activity during treatment were assessed and compared with changes in SH in joints with Doppler activity. They found:

• At baseline, 44.8% of all joints examined (n=5,225) had SH ≥1 and 50.7% of these had SH without Doppler activity.
• The improvement in SH was similar in joints with and without Doppler activity but, when adjusting for the baseline score of SH, joints with SH without Doppler had a higher tendency towards a decrease than joints with SH with Doppler activity independent of grade.