ARCTIC
Remission in patients with rheumatoid arthritis: a randomized controlled trial investigating the use of ultrasound in clinical follow-up
Project Manager
ABOUT THE PROJECT
The aim of the ARCTIC study was to assess whether a treatment strategy based on structured ultrasound assessment would give better results in early arthritis compared to a conventional strategy. The study was a multicentre, open, two-arm, parallel-group, randomized controlled strategy study, which was conducted at ten rheumatology departments and one specialist center in Norway.
The study was conducted from September 2010 to September 2015.
WHO CAN JOIN?
Inclusion of patients has ended.
The study included 238 patients recruited between September 2010 and April 2013. The inclusion criteria were age 18-75 years, arthritis according to the 2010 ACR/EULAR criteria for rheumatoid arthritis, not previously treated with disease-modifying anti-rheumatic drugs (DMARDs), indication for such treatment , and time from first reported swollen joint of less than two years.
WHAT DOES THE STUDY INCLUDE?
The patients were randomized in regard of the follow-up with either ultrasound and the goal of clinical and imaging-based remission (n=122) or a conventional close follow-up strategy with the goal of clinical remission (n=116). Both groups followed the same drug treatment strategy.
The primary endpoint was the proportion of patients with the combination of clinical remission, no swollen joints and no progression of radiographic joint damage between 16 and 24 months. Secondary outcomes included measures of disease activity, radiographic progression, function, quality of life and medical events. The results showed that 22% in the ultrasound group and 19% in the clinical control group reached the primary endpoint. The conclusion of the primary study was that the systematic use of ultrasound in the follow-up of early rheumatoid arthritis, treated in line with current recommendations, is not justified based on the ARCTIC results. The study emphasizes the need for randomized trials that assess the clinical application of medical technology. A number of sub-studies have been carried out based on data from the ARCTIC study, and several of these sub-studies are still ongoing.