Does patients’ opinion of remission in rheumatoid arthritis overlap ultrasound “true” remission? – a pilot study

Abstract

Aim: Patients describe rheumatoid arthritis (RA) remission as the absence of any symptoms or return to normality. Residual ultrasound (US) synovitis was frequently described in remission cohorts in previous studies. US tenosynovitis evaluation and scoring seems to better follow clinical remission scores compared with synovitis in RA. Our objective was to verify the presence of US findings suggestive of persistent inflammation in a cohort of patients in remission according to their own opinion.Materials and methods: Forty-three RA patients were prospectively enrolled in this pilot study between 2015-2017 according to their positive answer to the question “Are you feeling free of symptoms, just like before your RA symptomsstarted?”. Clinical evaluation of tender and swollen joints was performed in the same day with US evaluation of 24 joints and 26 tendon sites and lab C-reactive protein (CRP) evaluation. DAS28-CRP and SDAI were calculated. Results: A total of 72.9% (35 of 43) of patients were in remission per DAS28 criteria. Except for CRP value, no other variables were significantly different in the 35 of 43. PD scoring in tenosynovitis of the ankle and feet was 100% overlapping remission felt by patients. PD tenosynovitis in both upper and lower limbs was found in less than 10% of patients, and only grade 1 (minimal).Conclusion: A combination of patients’ opinion and PDUS evaluation could be a starting point for RA treatment tapering.

High Resolution Ultrasonography and Power Doppler in Evaluation of Disease Activity of Rheumatoid Arthritis Patients in Clinical Remission or Low Disease Activity

“…In addition, power doppler (PD) signals detected in the synovium of patients in remission predict further relapses, joint destruction and deterioration of functional status. (10)(11)(12)(13) .…”