Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: Power Doppler signal predicts short-term relapse
Scirè CA et al. – In a cohort of early RA patients treated with conventional DMARDs, ultrasonographic-grey scale (US-GS) can detect residual disease activity more sensitively than clinical examination both in active disease and in remission. Moreover, power Doppler (PD)-positive synovial hypertrophy identifies an ongoing inflammation even during remission and predicts short-term relapse. Methods- Aim was to evaluate the usefulness of a systematic musculoskeletal US assessment in detection of residual disease activity in pts with early RA who achieved clinical remission
- 106 early RA pts receiving conventional DMARDs according to DAS-steered therapeutic protocol over a 24-mo period
- Standard evaluation included clinical, laboratory, functional and systematic (44 joints) US assessment
- US indexes of GS and PD synovitis were correlated with clinical evaluation, laboratory indexes and clinical outcome
- Clinical remission was defined when DAS was <1.6 at 2 consecutive visits 3 mo apart
Results- US examination was more sensitive than clinical examination, both in active disease and in remission
- In pts with an active disease, both clinical and US indexes correlated with CRP, whereas in remission only PD still remained correlated
- In clinical remission, 95% of pts showed residual GS synovitis, and 41% of them showed a positive PD signal
- Positive PD signal, even in a single joint, resulted the main predictor of relapse within 6 mo
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