Background Treat-to-target strategy, aiming at clinical remission, has greatly improved the prognosis of RA. However, the ultrasonographic subclinical synovitis was correlated with bone erosion and disease flare.
Objectives The aim of this study was to evaluate whether deeper clinical remission (DAS28(ESR) ≤1.98) reflects the better control of subclinical synovitis.
Methods 126 RA patients in clinical remission were enrolled in the study. Disease activity and ultrasongraphy were evaluated at baseline, and every 3 months during a 12-month follow-up. The relationship between the extent of clinical remission, flare and ultrasonographic features was analyzed.
Results In 126 RA patients, 76 achieved deep clinical remission and 50 achieved mild clinical remission. In all, 54 (42.9%) patients relapsed at average of 6.8±3.3 months during follow-up. Patients in deep remission possessed not only lower risk to relapse (30.3% vs. 62.0%, P<0.01), but also longer duration of remission before relapse (8.1±3.3 vs. 5.9±3.1 months, P<0.05). Besides, applying DAS28(ESR) <1.895 to predict ultrasonographic remission defined as negativity of both PD and SH was highly accurate (P<0.001). Subclinical PD synovitis at baseline was an independent risk factor for predicting relapse in RA patients achieved clinical remission (OR 8.8 [95% CI 2.7–28.4]).
Conclusions Subclinical synovitis was common in RA patients even in deep clinical remission. The deeper the clinical remission, the milder the subclinical synovitis, and the lower risk to relapse. Therefore, achieving deeper clinical remission, which reflected better control of subclinical synovitis and less tendency to flare, could be an optimized treatment target of RA.
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Acknowledgement We thank our colleagues for their assistance in the aspect of data collection and statistics. The authors also gratefully acknowledge the contribution of the patients who participated in the study.
Disclosure of Interest None declared