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Clinical and ultrasonographic remission determines different chances of relapse in early and long standing rheumatoid arthritis
  1. Giusy Peluso,
  2. Alessandro Michelutti,
  3. Silvia Bosello,
  4. Elisa Gremese,
  5. Barbara Tolusso,
  6. Gianfranco Ferraccioli
  1. Correspondence to Professor G F Ferraccioli, Director Division of Rheumatology, UCSC- Catholic University of Rome, Complesso Integrato Columbus-CIC-Via G, Moscati, 31-00168 Rome, Italy; gf.ferraccioli{at}


Objectives Treatment of rheumatoid arthritis (RA) should aim at full remission. The aims of this study were to define: (1) how many patients reached ultrasound power Doppler (US-PD) remission in a cohort of patients with early RA (ERA) compared with longstanding RA (LSRA); (2) possible predictors of US-PD remission; and (3) how many patients with and without US-PD remission relapsed after 1 year of follow-up in ERA and LSRA.

Methods 48 patients with ERA and 46 with LSRA with disease activity score <1.6 underwent US assessment. Six hand and wrist joints were studied for active synovitis. 56.2% of patients with ERA and 50.0% of those with LSRA fulfilled American College of Rheumatology (ACR) remission criteria.

Results 43.7% of patients with ERA and 17.4% of those with LSRA had no evidence of synovitis at US evaluation. Using a stricter clinical definition of remission (ie, ACR criteria), US evaluation confirmed clinical remission in 66.7% of patients with ERA and 26.1% of those with LSRA. Early disease was predictive of clinical US remission. 20.0% of patients with RA who had a negative PD signal at the US evaluation had a flare during the 12-month follow-up period compared with 47.1% of patients who had a positive PD signal.

Conclusion US-PD remission occurs in half of patients with ERA and in a minority of patients with LSRA in clinical remission. Early disease seems to be the major determinant of full remission.

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  • Funding GFF has received consulting fees and speaking fees from Wyeth, Roche, Abbott and BMS (less than $10 000 each).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Catholic University ethics committee and informed consent was obtained from all patients before study entry.

  • Provenance and peer review Not commissioned; externally peer reviewed.