Background Remission is the principal purpose of treatment in rheumatoid arthritis (RA). Different scores and indices are available to define remission. However, even when the most stringent ones are used, structural damages can occur. The Ultrasonography (US) and especially Power Doppler seems to be the best way to assess true remission and avoid future disabilities.
Objectives To assess the association of clinical and/or serological parameters with ultrasound defined remission in RA.
Methods A prospective study of 68 Tunisian RA patients was performed. US examination was performed by an experienced rheumatologist blinded to the statue of activity of RA. For each patient 22 joints were scanned: wrists, metacarpo-phalangeal, and proximal interphalangeal joints. A binary score (absence or presence) of synovial hypertrophy/effusion (SH) and power Doppler (PD) signals was applied for each joint. The Sonographic Remission was defined by the absence of PD signals. Visual analogic scale of pain (VAS), Global assessment of disease activity by the patient (GAP), duration of morning stiffness (MS), number of night awakening (NA), tender joint count (TJC), swollen joint count (SJC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and health assessment questionnaires (HAQ) were recorded and compared between patients who were in Sonographic Remission (G1) or not (G2).
Results Over the 68 patients recruited, 85% were females. The mean age was 50 years-old [30-70]. Among patients, 30 were diagnosed in remission according to the Disease Activity Score 28 joints and only 13 of them were in remission according to ultrasound. PD signals as a sign of active disease were observed in 53 (78%) patients. Main results are presented in table 1. VAS, GAP and CRP were significantly higher in G2 than in G1.
Conclusions According to our study, sonography-defined disease activity is associated with VAS, GAD and CRP. VAS and GAD, although usually considered as subjective criteria, seem useful for evaluating RA remission.
Vasanth LC. Imaging of rheumatoid arthritis. Rheum Dis Clin North Am 2013
Disclosure of Interest None declared