Background Studies using ultrasound (US) showed that a significant proportion of patients thought to be in clinical remission actually exhibited different grades of synovitis, and a subgroup of these patients suffered from flares and/or joint damage during follow-up1.
Objectives Evaluate joint inflammation by ultrasound in patients with different stages of rheumatoid arthritis as the primary endpoint measure.
Methods Gray scale and power Doppler ultrasound were performed on the dorsal radio-scaphoid, dorsal radio-lunae, ulnar-triquetrium, and palmar radio-lunate joints of both wrists. The presence of synovitis, comorbidities, and use of disease modifying anti-rheumatic drugs were recorded. Patient with a bilateral wrist score sum (GSUS + PDUS) equal or greater than 4 was considered to have sonographic inflammation. A logistical regression model was used to identify factors associated with inflammation.
Results There were 1248 patients (1010 females, 238 males; mean age: 59.61 ± 12.19 years). Synovitis was most common at the dorsal radio-lunate joint. Patients with high disease activity (DAS28 >5.1) had more sonographic inflammation than those with moderate or low disease activity. Most patients (57.4%) in complete remission (DAS28 <2.6) had subclinical synovitis (Table). Logistical regression analysis indicated that male sex, smoking, and liver disease are positively associated with inflammation and that advanced age, alcohol consumption, hypertension, gastrointestinal disease, and use of MTX, glucocorticoid, or a biological therapy are negatively associated with inflammation. Use of biological agents decreased the risk of inflammation by 40.9%.
Conclusions There was sonographic evidence of synovitis in most patients who were in complete remission. Regular monitoring of rheumatoid arthritis patients with ultrasound and DAS28 may help prevent disease flare-ups and joint destruction.
Brown AK, et al. Arthritis and Rheumatism 2006;54:3761–3773.
Disclosure of Interest None declared