Background Remission is regarded as the best therapeutic target for patients with rheumatoid arthritis (RA). Clinical trial evidence has demonstrated a disparity between clinical status and outcome (ongoing progression of joint damage despite clinical remission (clin.remission)). Imaging techniques are capable to provide a more accurate measure of disease activity.
Objectives To assess the association of clinical and/or serological parameters of disease activity and the structural damage with ultrasound (US) defined remission in RA.
Methods Prospective analysis of 42 consecutive RA patients (pts) [median age 48 (range 39-55) years; disease duration 58 (36-96) months; disease activity score-28 (DAS28) 3.9 (2.9-5.2); 74% female; 84% “+” for rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACCP)] in therapy with anti-IL 6 receptor antibody. US was performed at baseline and after 6 months by a single operator, unaware of clinical data (“Voluson-i” (GE,USA) with array transducer (4-13MHz)). The US assessment included bilateral of the wrists and the metacarpo-phalangeal joints. Semiquantitative scoring of power Doppler (PD) signals was calculated. Definitions of sonographic remission were determined as strict imaging remission - the absence of the PD-signals (PD=0) and a less strict criterion was used to indicate low level imaging activity (PD≤1). Number of tender (TJ) and swollen joints (SJ), global assessment of disease activity by the pt (VAS-pt), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) were recorded. Clin.remission was defined when DAS28-ESR was <2.6, low disease activity state (LDA) - DAS28-ESR ≤3.2 after 6 months. Hand, feet X-ray were performed at the entry and at one year.
Results PD-signals as a sign of active disease were observed in 32 (76%) cases after 6 months. Strict imaging remission (PD=0) was found at 10 pts, a less strict criterion imaging remission (PD≤1) – at 20 cases. Clin.remission was achieved at 7 pts, LDA - at 4 pts (total n=11). Out of them 6 of 7 who fulfilled clin.remission and 8 of 11 (clin.remission or LDA) showed the positivity of PD signal (at least at one site). However, in all pts with RA in clin.remission or with LDA at 6 month we found lower baseline the USPD score (median 3 (range 2-5) vs. 5 (3-8), p=0,01), than those in pts with DAS28-ESR >3.2 at 6 month. The total Sharp Score modified by van der Heijde at one year [56 (31-98) vs. 109.5 (68.5-185) units, p<0.02] was higher in pts with PD-signals >1 (n=22) than in cases with more low imaging activity and the absence of the PD-signals (n=20). However, there was no significant difference between these markers in RA pts with strict imaging remission (PD=0). The other parameters showed no association with the presence or absence of PD-signals.
Conclusions These results confirmed that satisfying clin.remission criteria may not accurately reflect an absence of synovial inflammation. Pts with PD-signals >1 have the high risk for radiological progression. PDUS demonstrated to be useful in evaluating patients considered to be in remission.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.