Background A high proportion of patients with rheumatoid arthritis (RA) in clinical remission (CR) present subclinical synovitis when evaluated by sonography. Most prospective studies on baseline biomarkers of radiographic progression in this patients not include immunological biomarkers that could be of interest to better identify the residual inflammatory activity.
Objectives To determine clinical, serological and ultrasonografic variables predicting progression of structural damage as evaluated by MRI at 12 months (mo.) of follow-up in a cohort of RA patients in CR.
Methods We included 42 RA patients in CR defined as DAS28-ESR<2.6 for >6 mo. Complete clinical and biological assessment, ultrasonography of two hands and MRI of dominant hand were performed at baseline and after 12 mo. We analyzed risk factors related with RAMRIS progression with multivariate lineal models.
Results 42 patients were included (76.7% female). Mean age was 53.5 years, body mass index (BMI) 26.7 kg/m2. Disease and remission median duration were 94 and 37 mo. respectively. 73.8% RF[+] patients and 85.7% ACPA [+]. RAMRIS 10.3 and erosion (RAMRIS) 18.8. At baseline, 66.7% had power-doppler (PD) signal and 45.2% also had synovial hyperplasia grade ≥2, so fulfilling the criteria of previously defined ultrasound defined active synovitis (UdAS)1. The risk factors more related with RAMRIS progression at 12 mo. were baseline RAMRIS, BMI, disease duration, low-dose prednisone treatment, absence of csDMARDs treatment and presence of UdAS. Synovitis as defined by only PD positive signal was no associated to erosions.
We excluded the baseline RAMRIS in the multivariate model because it was the strongest predictor factor. We observed that higher serum levels of calprotectin and ENA78 at baseline were significant predictors. Absence of csDMARD treatment, disease duration and the presence of UdAS also remained as independent predictive factors (Table 1).
Conclusions This prospective study confirms a high prevalence of UdAS in patients with RA in CR, which is an independent risk factor to develop structural damage progression at 12 months of follow-up. Baseline RAMRIS, BMI, disease duration, absence of csDMARDs therapy, UdAS, and baseline levels of calprotectin and ENA78, were independent predictors of RAMRIS progression.
Ramírez J, et al. Patients with rheumatoid arthritis in clinical remission and ultrasound-defined active synovitis exhibit higher disease activity and increased serum levels of angiogenic biomarkers. Arthritis Res Ther. 2014;16(1):R5
Disclosure of Interest None declared