The discrepancy between clinical and ultrasonographic remission in rheumatoid arthritis is not related to therapy or autoantibody status

Abstract

To evaluate the clinical remission by means of power Doppler ultrasonographic (PDUS) monitoring in a group of patients with rheumatoid arthritis (RA) in clinical remission (DAS28 < 2.6). The study included 54 patients with RA in therapy with DMARDS, anti-TNF, or no therapy in clinical remission according to ACR criteria and DAS 28 < 2.6 for at least 6 months. All patients had active wrist or hand inflammation in the past. US examination evaluated the presence of active synovitis, power Doppler signal, and synovial hypertrophy on the following bilateral joints: metacarpophalangeal-proximal interphalangeal joints-flexor tendons (on 2°-3° fingers) and wrist (radiocarpal and midcarpal joints). In 19 patients, there was an agreement between clinical and US parameters. However, 35 patients with clinical remission showed a positive ultrasonographic assessment and at least an active parameter. No statistic correlation was found between US examination and antibody assessment (anti-CCP and/or RF). Patients in therapy with anti-TNF or other therapies showed similar US assessment without significant statistical differences. Among eleven patients that presented swollen and tender joints at the latest physical examination, which preceded US exam, just 5 patients had an US confirmation too. In the other patients, the PDUS did not confirm the presence of inflammation in the corresponding swollen and tender joints or showed a positive ultrasonographic assessment in other locations. The remission state is a great therapy target and not only through the biological therapy. Synovial inflammation could persist independently from type of therapy or autoantibody status.

Factors influencing ultrasonographic remission in patients with rheumatoid arthritis

“…Spinella et al [23] showed that synovial disease might persist despite application of therapy and (good) autoantibody status. The US findings in a TNF-blocker group and those taking other therapies were similar.…”

Role of ultrasound in assessing remission in rheumatoid arthritis

“…Indeed, B-mode and PD synovitis were detected in 50.7% [20] to 95% of cases [19] and 14.7% [13] to 57.4% of cases, respectively [17]. Only three studies reported the exact number of clinically non swollen joints and the percentage of those with US synovitis among them [9,10,14].…”

“…The predictive value of B-mode for relapse was only studied in two articles and was not statistically significant [13,19]. Role of ultrasound in assessing remission in rheumatoid arthritis 5 [9,10] 8 Wrist (4 joints) MCP 2-5 Dominant hand Peluso et al, [16] Spinella et al, [17] 12…”

“…When SDAI criteria were used (with a cutoff of 3.3), only 29 to 44% were in remission. The duration of remission according to these scores varied from 2 [13] to 6 months [14][15][16][17].…”

The Time Course of Changes in Biomarker Levels and the Ultrasonic Signs of Inflammation in Patients With Rheumatoid Arthritis

“…Не было обнаружено связи между УЗ-динами-кой синовита и характером терапии (монотерапия под-кожным МТ или комбинированная терапия подкожным МТ и ГИБП). Это совпадает с данными других авторов, которые не отметили различий в динамике ультразвуко-вой картины синовита у пациентов, получавших ингиби-торы ФНОα или монотерапию МТ [43,44]. Это имеет принципиальное значение, поскольку персистенция «субклинического» воспаления у больных РА, находя-щихся в «клинической» ремиссии (или имеющих низкую активность заболевания), ведет к нарастанию деструктив-ных изменений в суставах и функциональной недостаточ-ности [10,45] и ассоциируется с обострением заболева-ния после отмены терапии [46].…”