Article Text

THU0095 Impact of ultrasound-detected tenosynovitis and synovitis on disease flare, disability and radiographic progression in patients with ra in clinical remission: results of the starter study
  1. G Sakellariou1,
  2. G Filippou2,
  3. E Bellis3,
  4. CA Scirè4,
  5. G Carrara5,
  6. A Iagnocco6,
  7. on behalf of STARTER study group and US Study Group of the Italian Society for Rheumatology
  1. 1IRCCS Policlinico San Matteo Foundation, Pavia
  2. 2University of Siena, Siena
  3. 3Ospedale Mauriziano, Torino
  4. 4Italian Society for Rheumatology, Milan
  5. 5Italian Society for Rheumatology, Milano
  6. 6Università degli Studi di Torino, Torino, Italy


Background In patients with RA in remission subclinical ultrasonographic (US) synovitis (-S) relates to flare and radiographic progression. The impact of tenosynovitis (-T) on flare, disability and radiographic progression is not known.

Objectives To evaluate the predictive role of US-detected tenosynovitis and synovitis in RA patients in remission on flare, disability and radiographic progression over 12-months.

Methods STARTER is a multicentre cohort study of the US Study Group of the Italian Society for Rheumatology. Participants were selected on the basis of a reliability exercise and the availability of high-end equipment with high frequencies probes. Patients with RA in remission underwent clinical and US evaluation. US -T and -S were assessed categorically by Grey Scale (GS) and power Doppler (PD) at 11 joints, extensor and flexor tendons in both hands. Patients were assesed at baseline, 6 and 12 months. The primary outcome was flare within 12 months (defined as increase in DAS28>1.2 or >0.6 if final DAS28>3.2). The secondary outcomes were progression of disability (increase ≥2.3 in the Health Assessment Questionnaire (HAQ)) and radiographic progression (increase in the total Sharp van Der Hejide score (SHS) ≥4.3) at 12 months. Logistic models were used to measure the relationship between GS-T/-S, PD-T/-S and outcomes, results were presented as odds ratios (OR) and 95% confidence interval (CI), adjusted for pre-specified confounders.

Results 361 patients (72.3% f, mean age (sd) 56.1 (13.3), median disease duration (IQR) 7.1 years (3.6–13.5)) were included, complete radiographs were available for 189/361 (52.3%) patients. 98/326 (30.6%) patients had a flare within 12 months, 70/340 (20.59%) had an increase in HAQ and 39/189 (20.6%) radiographic progression. Results are presented in Table 1. Flare was predicted only if –T and –S, assessed by both GS and PD, were concurrently present, while both –T and-S and their combination did not predict HAQ or SHS progression.

Table 1

Conclusions In patients with RA in clinical remission, US-detected synovial and tenosynovial inflammation relates to the risk of flare, while in a short term follow-up the effect on disability and radiographic progression is limited. These results might have been influenced by the short follow-up and limited power for secondary outcomes. US might integrate the clinical management of RA patients in clinical remission.

Disclosure of Interest None declared

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.