Limited value for ultrasonography in predicting flare in rheumatoid arthritis patients with low disease activity stopping TNF inhibitors

Lamers-Karnebeek, F.; Luime, Jolanda J.; Cate, David F Ten; Teerenstra, Steven; Swen, Nanno; Gerards, A.; Hendrikx, Jos; Rooyen, Emma M van; Voorneman, R.E.; Haagsma, C.J.; Basoski, N.; Jager, Mike; Moghadam, Marjan Ghiti; Efdé, M.; Goekoop-Ruiterman, Yvonne P M; Riel, P.L.C.M. van; Jacobs, Johannes W G; Jansen, Tim

doi:10.1093/rheumatology/kex184

Cited by 20 publications

(8 citation statements)

References 18 publications

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“…In accordance with previously published data, we showed that PD synovitis may be a predictor of tapering failure 18,22,30 . In our study, patients with a US PD score ≥1 had significantly greater chances to relapse, indicating that power Doppler activity may be related to an incomplete suppression of inflammation, and, for this reason, patients without PD could be a more appropriate population for tapering DMARD.…”

Section: Discussionsupporting

confidence: 92%

Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long‐Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity

Massignan

Chakr

Andrade

et al. 2021

J of Ultrasound Medicine

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Objectives This study aimed to investigate the predictive value of synovitis and tenosynovitis detected by grayscale (GS) and by power Doppler (PD) ultrasound (US) in relation to failure of tapering disease‐modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients. Methods Long‐standing RA patients who de‐escalated treatment were included in this prospective cohort study. All patients underwent 3 ultrasonographic and clinical assessments, at baseline and every 3 or 4 months, over a period of 6–8 months. US investigation of 32 joints was performed. Synovitis was assessed by GS and PD semiquantitative scoring (0–3) and a global score was calculated for each individual by summing single joint scores. The presence of tenosynovitis was recorded whenever detected during ultrasound assessment. Results Thirty‐three patients completed the follow‐up period (29 women; 4 men). Eight patients (25%) relapsed. Using the optimal cutoff values determined by receiver operating characteristic curve, patients with a PD synovitis ≥1 at baseline had significantly greater chances to relapse than those without PD activity. During follow‐up, GS tenosynovitis was detected in 6 patients (5 with PD) who failed and in 3 patients (1 with PD) who succeeded in tapering therapy. Having at least 1 joint with PD synovitis resulted in a relative risk of 3.14 and having GS tenosynovitis resulted in a relative risk of 11.4 (95% CI: 1.03–9.60 and 2.82–45.9, respectively) for relapse in the multivariate Poisson model. Conclusions PD synovitis and GS tenosynovitis may be useful to identify RA patients in risk of relapse after DMARD tapering.

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Section: Discussionsupporting

confidence: 92%

Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long‐Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity

Massignan

Chakr

Andrade

et al. 2021

J of Ultrasound Medicine

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“…This is likely a reflection of the high proportion of patients in our cohort who had ultrasound activity at baseline. In the POET study only 63% of patients had US sign of arthritis with positive power Doppler signal [30]. This is partly explained by our cohort, which included a greater proportion of patients, one third, with low disease activity state (LDAS) above the DAS-28 remission cut-off.…”

Section: Discussionmentioning

confidence: 99%

Flares in Rheumatoid Arthritis Patients with Low Disease Activity: Predictability and Association with Worse Clinical Outcomes

Bechman

Tweehuysen²,

Garrood³

et al. 2018

J Rheumatol

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“…Lamers-Karnebeek, et al reported on MSK-US in a 1-year prospective study of patients with RA in low disease activity or remission who stopped antitumor necrosis factor agents. MSK-US could not predict flare on an individual level 13 . Thus, the 2 main reasons for MSK-US in patients with RA in remission are for prevention of damage from ongoing synovitis and prediction of flare, especially when medication de-escalation needs to be considered.…”

Section: Chasing the Ghost Of Imaging Remission In Rheumatoid Arthritismentioning

confidence: 88%

Chasing the Ghost of Imaging Remission in Rheumatoid Arthritis

Kaeley

Ranganath

2018

J Rheumatol

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Limited value for ultrasonography in predicting flare in rheumatoid arthritis patients with low disease activity stopping TNF inhibitors

Cited by 20 publications

References 18 publications

Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long‐Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity

Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long‐Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity

Flares in Rheumatoid Arthritis Patients with Low Disease Activity: Predictability and Association with Worse Clinical Outcomes

Chasing the Ghost of Imaging Remission in Rheumatoid Arthritis

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