Background Patients describe RA remission as the absence of any symptoms or return to normality. Ultrasound (US) in RA remission patients did not exactly overlap clinical evaluation of remission in previous studies (residual synovitis frequently described). US tenosynovitis evaluation and scoring seemed to better follow clinical remission scores than synovitis in RA .
Objectives To verify with US/clinical evaluations if patients' reported remission is “true” remission, and if and which clinical and US scores are lowest possible in that cohort.
Methods Forty-eight RA patients were enrolled in this pilot study between 2015–2017 according to their positive answer to the question “Are you feeling free of symptoms, like before RA started for you?”; the enrollment was regardless of the treatment they were on. Written informed consent was obtained. Clinical evaluation of tender and swollen joints was performed the same day with US evaluation of 24 joints and 26 tendon sites and with lab CRP evaluation, blinded from one another. DAS28 and SDAI were calculated after, counting VAS=1, for both physician and patients.
Results Mean patients age was 58, 35/48 (72.9%) patients were also in remission per DAS28 criteria. Except for CRP value, no other variables (tender, swollen joints, RF, CCP, remission duration) were significantly different in the group with overlapping DAS28 remission. Considering 1.00 as the “ideal” situation (absolute overlapping of US remission and remission felt by patients), the closest was PD scoring in tenosynovitis of the ankle and feet (100%) and the furthest was GS scoring of synovitis in superior and inferior limbs (mean 17.1%)-table 1. Although residual synovitis and tenosynovitis in remission RA patients did not exhibit a statistically significant difference, PD tenosynovitis in both upper and lower limbs was found in less than 10% of patients. This confirms the results from our previous cohort , that tenosynovitis better overlaps RA remission than synovitis.
Conclusions The way patients perceive their disease activity is not related to either DAS28, SDAI scores or to objective US assessment of joints and tendons (GS or PD). However, PD signal especially in tendons sheaths seems to be absent in patients having a normal life, according to their own opinion. Consequently, patients in remission could benefit from US evaluation on any machine, regardless of its costs and Doppler settings. GSUS synovitis/tenosynovitis can be residual finding and does not imply any dissatisfaction in patients' health. An ongoing cohort of active RA patients is currently conducted to explore the validity of this conclusion in these cases, too.
Vlad V et al. Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy. Med Ultrason 2015 Sep;17(3):352–60.
Disclosure of Interest None declared
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