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Power Doppler Treatment Guidance — SCE Rheumatology MCQ

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HardMusculoskeletal ImagingPower Doppler Treatment GuidanceSCE Rheumatology

A treated rheumatoid-arthritis patient is at the agreed clinical target but ultrasound still shows power-Doppler synovitis. What principle should guide management?

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Correct answer: B — Use clinical treat-to-target and avoid imaging-driven escalation

The best answer is “Use clinical treat-to-target and avoid imaging-driven escalation”. Ultrasound can demonstrate residual inflammation, but a strategy of routine imaging-driven escalation has not improved outcomes over clinical treat-to-target care and can increase treatment intensity. Doppler is not proof of infection, does not justify stopping therapy, and should not become the sole weekly target.

Reference: ARCTIC randomized strategy trial: https://www.bmj.com/content/354/bmj.i4205