Background Treatment strategies nowadays are targeting clinical remission or low disease activity. In some patients with psoriatic arthritis (PsA) clinical findings defer from the ultrasonographic evidence of inflammation which raise the need for revising the remission criteria in the clinical practice.
Objectives The aim of our study was to estimate the presence of subclinical synovitis by power Doppler ultrasonography (PDUS) in PsA patients, who were considered as being in clinical remission defined by DAS28-ESR (Disease activity score of 28 joints – erythrocyte sedimentation rate) for at least 6 months during the treatment course.
Methods 64 PsA patients in clinical remission based on DAS28 – ESR <2.6 were included in the study. The patients were examined by two independent rheumatologists. The affected joints were assessed by PDUS (MyLab 60, Esaote) for the presence of synovial hypertrophy (SH) and synovitis scored from 0 to 3 based on the presence and intensity of PD signal. Disease activity was determined by the presence of SH ≥2 degree and a positive PD signal.
Results We found a persistent synovitis in 23 (35.9%) of the PsA with clinical remission of the peripheral joint involvement. Active synovitis was also found in 7 (10.9%) of the patients with DAS28 <2.6 which were on systemic corticosteroid (CS) treatment regimen.
Conclusions The presence of active synovitis on PDUS in a significant part of the studied PsA patients (35.9%) which were considered as being in clinical remission for at least 6 months showed that these kind of patients need to be closely followed-up and adequately treated. The systemic CS treatment does not exclude the presence of disease activity in PsA. Further studies for assessment of the synovitis will establish correct criteria for defining and monitoring the disease activity in PsA.
Disclosure of Interest None declared