Article Text

OP0217 Ultrasound-Detected Synovitis and Tenosynovitis Independently Associate with Flare in Patients with Rheumatoid Arthritis in Clinical Remission
  1. E. Bellis1,
  2. C.A. Scirè2,
  3. G. Carrara2,
  4. A. Adinolfi3,
  5. A. Batticciotto4,
  6. A. Bortoluzzi5,
  7. G. Cagnotto6,
  8. M. Caprioli7,
  9. M. Canzoni8,
  10. F.P. Cavatorta9,
  11. O. De Lucia10,
  12. V. Di Sabatino3,
  13. A. Draghessi11,
  14. G. Filippou3,
  15. I. Farina5,
  16. M.C. Focherini12,
  17. A. Gabba13,
  18. M. Gutierrez11,
  19. L. Idolazzi14,
  20. F. Luccioli15,
  21. P. Macchioni16,
  22. M.S. Massarotti17,
  23. C. Mastaglio18,
  24. L. Menza18,
  25. M. Muratore19,
  26. S. Parisi20,
  27. V. Picerno3,
  28. M. Piga21,
  29. R. Ramonda22,
  30. B. Raffeiner22,
  31. D. Rossi23,
  32. S. Rossi6,
  33. P. Rossini24,
  34. G. Sakellariou6,
  35. C. Scioscia25,
  36. C. Venditti26,
  37. A. Volpe27,
  38. M. Matucci-Cerinic28,
  39. A. Iagnocco29
  40. on behalf of MSUS Study Group of SIR
  1. 1Osp.Mauriziano, Torino
  2. 2SIR, Milan
  3. 3University of Siena, Siena
  4. 4H Sacco, Milan
  5. 5A.O.U. S.Anna, Ferrara
  6. 6Osp. S.Matteo
  7. 7Istituto di Cura Città di Pavia, Pavia
  8. 8A.O. S.Andrea, Roma
  9. 9A.O.U. S.Chiara, Trento
  10. 10G.Pini, Milan
  11. 11Università delle Marche, Jesi
  12. 12Osp. Infermi, Rimini
  13. 13A.O.U. di Cagliari, Cagliari
  14. 14Osp. Civile Maggiore, Verona
  15. 15University of Perugia, Perugia
  16. 16Arcispedale S.M.Nuova, Reggio Emilia
  17. 17Humanitas, Rozzano
  18. 18Moriggia-Pelascini, Gravedona
  19. 19Osp. Galateo, Lecce
  20. 20A.O.Città della Salute e della Scienza, Torino
  21. 21Osp. Cagliari, Cagliari
  22. 22University of Padua, Padova
  23. 23Osp. G.Bosco, Torino
  24. 24P.O.Destra Secchia, Pieve di Coriano
  25. 25University of Bari, Bari
  26. 26A.O. Rummo, Benevento
  27. 27A.O.U.P.S.Chiara, Trento
  28. 28University of Florence, Firenze
  29. 29Sapienza University, Roma, Italy


Background Remission is the target of treatment in rheumatoid arthritis (RA). In clinically-defined remission, subclinical disease activity may persist leading to flare and joint damage progression. Musculoskeletal ultrasonography (MSUS) is a good candidate to overcome the limitations of clinimetric indexes. The role of MSUS synovitis is well-known in the literature but no data are available for tenosynovitis.

Objectives The study aims to evaluate the association between US synovitis (S) and tenosynovitis (T) and 6-month flare in RA patients in clinical remission.

Methods The STARTER study is a multicentre cohort study promoted by the Italian Society for Rheumatology. Ultrasonographers were selected by an inter-reader reliability exercise. Consecutive patients with RA and clinical remission underwent a full clinical evaluation and Grey Scale (GS) and power Doppler (PD) US exam (assessing -S and -T) at wrists, MCP, PIP and extensor/flexor tendon sheets. Six-month flare was defined as: 1) increase of >1.2 or >0.6 if final DAS28>3.2; 2) change in treatment; 3) change of >4 points in the flare questionnaire (FQ) if FQ<4 at baseline. The relationships between presence of GS-T/-S, PD-T/-S were evaluated by logistic models, presented as odds ratios (OR) and 95%CI, adjusted for pre-specified confounders.

Results A total of 427 patients were included in the analyses: 113 (26.5%) men, mean (SD) age 56.6 (13.4), median (IQR) disease duration 7.3 (3.8-13.5) years, median (IQR) remission duration 12 (8-24) months, RF positive 287 (67.4%), mean (SD) DAS28 2.2 (0.8), median (IQR) HAQ 0.125 (0-0.375), on DMARDs 322 (75.4%), on biologics 183 (42.9%), on glucocorticoids 187 (43.8%). GS-T was present in 198/373 (53.1%) patients, PD-T in 88/372 (23.7%) while GS-S in 270/368 (73.4%) and PD-S in 171/372 (46.5%). The association between US variables and flare is reported in the Table.

Conclusions MSUS PD-S confirms its predictivity on flare defined according to DAS28 definitions while PD-T is more specifically associated with patient-related flare and symptoms exacerbation. US-T should be take into account in the 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.