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Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: Power Doppler signal predicts short-term relapse
Rheumatology, 07/01/09

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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