Background Active synovitis may persist even with apparent succesfull biologic treatment.
Objectives To correlate clinical evaluation with disease activity (SDAI) and ultrasound parameters in remission rheumatoid arthritis patients on stable biologic treatment.
Methods This was a prospective study evaluating rheumatoid arthritis (RA) patients on biologic treatment for at least 6 months. Clinical and US (ultrasound) evaluation were performed by two independent assessors, the same day as all laboratory tests. The scanning technique and the settings of the machine (ESAOTE MY LAB70, 15 MHz linear probe) were the same for all the patients. Examinations were perform by a trained ultrasonografer who was blinded to all clinical evaluations. US of both hands (dorsal wrist, 2nd to 5th volar metacarpophalangeal and 2nd to 4th volar proximal interphalangeal) was done. Synovial hypertrophy and power Doppler (PD) signal were scored (grade 0–3). Synovial hypertrophy >2 plus power Doppler signal was classified as active synovitis. Patients classified as being in SDAI remission were subclassified according to active US synovitis. Statistical analysis was performed using IBM SPSS v20.0.
Results Initially 106 consecutive RA patients were evaluated, 84% were females, mean age 58.72 (11.49) years, mean disease duration 13.48 (7.4) years. 49.1% (52) patients were treated with rituximab, 27.35% (29) with etanercept, 19.9% (19) with adalimumab, 9.33% (9) with infliximab; 87.7% had a DMARD associated to the biologic. 27.4% (29) subjects were found in SDAI remission, but when US evaluation was performed 51.72% had active synovitis. Significant statistical difference was found between SDAI remission patients with and without active synovitis regarding quantitative CRP, patient's VAS and SDAI value but not regarding ESR, rheumatoid factor/ACPA or physician global assessment (see table). No significant statistical difference was found between clinical, paraclinical and US parameters when patients were assessed comparing the biologic agent used.
Conclusions CRP value arround upper normal value, patient's perception of disease activity and SDAI between 2-3.3 might be useful predictive factors for residual joint inflammation in patients with remission based on composite scores.
Acknowledgements This paper is partially supported by the Sectoral Operational Program Human Resources Development, financed from the European Social Found POSDRU/159/1.5/S/137390.
Disclosure of Interest None declared