Background Studies have previously demonstrated that ultrasound detected power Doppler (PD) activity (implying active synovial inflammation) may be present in a proportion of patients in clinical remission1,2 and this can be used to accurately predict subsequent radiographic structural progression.3 It may be hypothesised that such continued subclinical inflammation despite apparent remission as determined by traditional criteria may trigger a subsequent disease flare.
Objectives Our study aimed to determine subclinical joint inflammation in patients with rheumatoid arthritis by power Doppler ultrasound in patients with rheumatoid arthritis at 12 months of adalimumab therapy.
Methods Patients with RA who had received adalimumab therapy were enrolled. Patients underwent clinical, laboratory, and ultrasonographic assessment with power Doppler assessment of bilateral elbows (posterior recess), wrists (radio-carpal), second and third MCP joints (dorsal recess), MCP II and III, PIP II and III (dorsal recess), knee, ankle and MTPII and MTP V joint at 12th month.
Results Power Doppler ultrasound was performed in 62 patients (87 females and 18 males; mean age: 57.09±9.96 years). The mean baseline DAS28 were 8.13±9.52. Baseline PD score (mean ±SD) were 0.852 ±1.051 and after 12 month of adalimumab therapy, the PD score decreased to 0.23±0.42. Ultrasound was performed 12th month at various parts, with the mean GS score: most prominent at right wrist (.810±.924) and left wrist (.774±.909) (Table).Logistical regression confirmed diabetes, positive anti-CCP, high DAS28 had more sonographic inflammation, while hypertension and positive rheumatoid factor (RF) had less sonographic inflammation. MTX, glucocorticoid and cyclosporin therapy had increased inflammation.
Conclusions Our data confirm the evidence that even after 1 year of biological therapy, there were still persistent subclinical synovitis, more severe at wrist joints. Baseline high DAS28 and high PD activity had more prone to residual inflammation. So we recommended serial ultrasound follow up of PD ultrasound in patients with rheumatoid arthritis after adalimumab therapy.
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Brown AK, et al. Arthritis Rheum. 2006;54(12):3761–73.
Brown AK, et al. Arthritis Rheum. 2008;58(10):2958–67.
Disclosure of Interest None declared