OBJECTIVE: To determine the utility of ultrasonography in guiding modification 
of disease-modifying anti-rheumatic drug (DMARD) and steroid therapy for 
inflammatory arthritis (IA) in routine clinical practice.
METHODS: In this retrospective study, we analyzed DMARD and steroid use in IA 
patients referred to a rheumatologist-led ultrasound clinic. Power Doppler (PD) 
vascularity and greyscale (GS) synovial hypertrophy joint findings were 
categorized as positive/negative for each patient. The erythrocyte sedimentation 
rate (ESR) was used as a measure of disease activity.
RESULTS: We assessed single visit data for 46 adult IA patients: 67.4% (n = 31) 
rheumatoid arthritis (RA), 15.2% (n = 7) psoriatic arthritis, 10.9% (n = 5) 
spondyloarthritis, and 6.5% (n = 3) undifferentiated IA. The mean ESR was 28.8 
mm/h. Thirty-seven patients with both GS and PD ultrasound results were 
subsequently analyzed. All patients (n = 10) escalated and/or initiated on DMARD 
and 9/10 patients escalated or initiated on steroids were PD and GS positive. 
Six of seven patients with dose reduction and/or cessation of DMARDs and five of 
seven patients with dose reduction or cessation of steroids were PD negative. Of 
six patients who were GS positive and PD negative, three had dose reduction 
and/or cessation of DMARDs, while four had dose reduction of steroids; none of 
the six patients had DMARD/steroid escalation.
CONCLUSION: By clarifying joint inflammation in an IA cohort with overall low 
ESR, ultrasonography of physician-selected joints can improve clinical 
assessment, resulting in treatment modification. Positive PD findings were 
particularly influential, while the clinical significance of GS positivity alone 
requires further investigation.