Background Joint replacements continue to occur during a rheumatoid arthritis (RA) patient's lifetime despite significant advances in available treatment options. The purpose of this study was to examine and quantify synovitis in surgically operated joints by ultrasound (US) in RA patients starting a new therapeutic agent. Methods RA subjects were enrolled in either tocilizumab or tofacitinib open-label, investigator-initiated trials and were assessed by ultrasound. In a subset of RA patients with joint replacements and/or operations of joint areas (OJA; e.g. joint arthroscopies, fusions, and synovectomies), joint-level scores of synovitis were compared between replaced joints, OJAs, and native joints. Joint-level synovitis was measured by grayscale (GSUS (0-3)) and power Doppler (PDUS (0-3)) at baseline and follow-up (3-6 months). McNemar's test or Wilcoxon signed rank test utilized the mixed effects ordinal logistic regression models. Results Twenty RA patients had a total of 25 replaced joints and 24 OJA. All replaced joints had GSUS> 1 and 92% had PDUS> 1 at baseline, while OJA and native joints had lower evidence of GSUS> 1 (37.5, 38% respectively) and PDUS> 1 (45.8, 62% respectively). GSUS and PDUS semiquantitative scores improved significantly with treatment in replaced joints (p = 0.01, p = 0.007), and native joints (p < 0.001 both), but not OJA. Conclusions In RA, joint replacement does not eliminate or prevent ultrasound measured synovitis, where all replaced joints have some evidence of US synovitis. US can also act as a potential marker of response to therapy in replaced joints. Scoring US synovitis in replaced joints should be considered in ultrasound RA clinical trials. Trial registration ClinicalTrials.gov NCT01717859 (registered 10/31/2012); ClinicalTrials.gov NCT02321930 (registered 12/22/2014).

中文翻译：

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超声波检测类风湿性关节炎患者置换关节和其他手术关节的滑膜炎。

背景 尽管可用的治疗方案取得了重大进展，但在类风湿性关节炎 (RA) 患者的一生中，关节置换术继续发生。本研究的目的是通过超声 (US) 在开始使用新治疗剂的 RA 患者中检查和量化手术关节中的滑膜炎。方法 RA 受试者被纳入托珠单抗或托法替尼开放标签、研究者发起的试验，并通过超声评估。在部分接受关节置换和/或关节区域手术（OJA；例如关节镜检查、融合和滑膜切除术）的 RA 患者中，比较了置换关节、OJA 和自然关节之间的滑膜炎关节水平评分。在基线和随访（3-6 个月）时通过灰度（GSUS（0-3））和功率多普勒（PDUS（0-3））测量关节水平滑膜炎。McNemar 检验或 Wilcoxon 符号秩检验使用混合效应序数逻辑回归模型。结果 20例RA患者共置换关节25个，OJA 24个。所有替换关节的 GSUS> 1 和 92% 的基线 PUDS> 1，而 OJA 和天然关节的 GSUS> 1（分别为 37.5、38%）和 PUDS> 1（分别为 45.8、62%）的证据较低。GSUS 和 PPDUS 半定量评分在置换关节（p = 0.01，p = 0.007）和原生关节（两者均 p < 0.001）治疗中显着改善，但在 OJA 中没有。结论 在 RA 中，关节置换不能消除或预防超声测量的滑膜炎，所有置换的关节都有一些 US 滑膜炎的证据。US 也可以作为替代关节治疗反应的潜在标志物。在超声 RA 临床试验中应考虑对置换关节中的 US 滑膜炎进行评分。试验注册 ClinicalTrials.gov NCT01717859（2012 年 10 月 31 日注册）；ClinicalTrials.gov NCT02321930（2014 年 12 月 22 日注册）。