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

Abstract

Background: Chronic Achieving remission or at least low disease activity is the ultimate goal of rheumatoid arthritis patients' treatment nowadays. Defining remission using indices based on clinical and laboratory biomarkers was proved to be lacking sensitivity to detect low levels of inflammation. Musculoskeletal ultrasound (MSUS) has been able to detect and quantify subclinical synovitis, with more specificity and reliability. Aim: To detect the persistence of GS and PD signals in RA patients in clinical remission or LDA as assessed by DAS28-ESR. Patients and methods:: Fifty consecutive RA patients in clinical remission or LDA were included. Patients were subjected to routine laboratory work up, RF and Anti-CCP measurement. Disease activity was determined by DAS28-ESR. US7 score was used to assess synovitis and vascularization with GSUS and PDUS respectively. Results: All patients in LDA showed activity by GSUS or PDSUS. 13 (38.2%) patients of those in clinical remission showed subclinical GSUS or PDUS activity, while 21 (61.2%) were in clinical and US remission. Female patients showed more tenosynovitis PDUS signals than males (P=0.039). There was no statistically significant difference between patients on cDMARDs and bDMARDs regarding the US7 score. Anti-CCP showed statistically significant difference between patients in true remission and patients with subclinical US activity (P=0.006). A strong correlation was found between Anti-CCP and S-PDUS in patients with subclinical US activity (P=0.001), and T-GSUS in same group of patients (P=0.023). Conclusion: Subclinical synovitis is a frequent finding in the joints of RA patients in clinical remission or LDA and occurs independently from the treatment. This may reclassify patients with either LDA or clinical remission. Female patients show more frequent subclinical PDUS activity. Anti-CCP levels of RA patients in clinical remission with subclinical synovitis correlated with PD signals and tenosynovitis GS.