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Musculoskeletal ultrasound using superb microvascular imaging documents treatment response to biosimilar infliximab in rheumatoid arthritis
  1. Julian Alejandro Santos1,
  2. Cherica Afurong Tee2,
  3. Romelito Jose Galvan Galsim1 and
  4. Michael Lucas Tee3,4
  1. 1Department of Radiology, Philippine General Hospital, Manila, Metro Manila, Philippines
  2. 2Division of Pediatric Rheumatology, Department of Pediatrics, Philippine General Hospital, Manila, Metro Manila, Philippines
  3. 3Department of Physiology, University of the Philippines Manila College of Medicine, Manila, Metro Manila, Philippines
  4. 4Division of Rheumatology, Department of Medicine, Philippine General Hospital, Manila, Metro Manila, Philippines
  1. Correspondence to Dr Michael Lucas Tee; mltee{at}


A 60-year-old woman with rheumatoid arthritis consulted for acute flare. She had elevated disease activity score 28 - erythrocyte sedimentation rate (DAS 28-ESR) of 6.88 and clinical disease activity index (CDAI) of 32. Her 12-joint ultrasound revealed widespread joint effusion. Synovial vascularity scores measured through superb microvascular imaging (SMI) and power Doppler were universally increased. We documented her treatment response 2 weeks after she received a single dose of biosimilar infliximab using clinical and sonographic data. Her DAS 28-ESR and CDAI scores decreased to 4.21 and 7.0, respectively. Reduction in synovial vascularity scores was demonstrated using SMI. While there was near total resolution in joint effusion and tenosynovitis, SMI was able to demonstrate synovial vascularity in joints with no clinical swelling nor tenderness. Musculoskeletal ultrasound and superb microvascular imaging are useful adjuncts in evaluating synovitis in rheumatoid arthritis and documenting treatment response through documentation of synovial vascularity, effusion and tenosynovitis.

  • radiology
  • rheumatoid arthritis
  • biological agents

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  • Contributors JAS, MLT and CAT were involved in writing the manuscript. MLT performed the clinical evaluation and acquisition of clinical data. JAS and RJGG performed the ultrasound examination and review of images. The final manuscript was reviewed, edited and approved by the authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

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