Persistence of subclinical sonographic joint activity in rheumatoid arthritis in sustained clinical remission

Gärtner, Miriam; Alasti, Farideh; Supp, Gabriela; Mandl, Péter; Smolen, Josef S.; Aletaha, Daniel

doi:10.1136/annrheumdis-2014-207212

Cited by 20 publications

(12 citation statements)

References 9 publications

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“…It has been observed that subclinical synovitis is long-lasting in RA patients in clinical remission [59]. In a study dated from 2012, pD, but not low-field MRI, predicted relapse and radiographic progression in RA patients with low levels of disease activity [60].…”

Section: Correlation Of Msus With Physical Examination Inflammatory mentioning

confidence: 99%

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

et al. 2018

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High-resolution musculoskeletal ultrasound (MSUS) has been increasingly employed in daily rheumatological practice and in clinical research. In rheumatoid arthritis (RA), MSUS can be now considered a complement to physical examination. This method evaluates synovitis through gray-scale and power Doppler and it is also able to identify bone erosions. The utilization of MSUS as a marker of RA activity has received attention in recent literature. Current data account for good correlation of MSUS with classical measures of clinical activity; in some instances, MSUS appears to perform even better. Diagnosis of subclinical synovitis by MSUS might help the physician in RA management. With some variation, interobserver MSUS agreement seems excellent for erosion and good for synovitis. However, lack of MSUS score standardization is still an unmet need. In this review, we describe several MSUS scores, as well as their correlation with clinical RA activity and response to therapy. Finally, we look at the relationship of MSUS with synovial tissue inflammation and discuss future perspectives for a better interpretation and integration of this imaging method into clinical practice.

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Section: Correlation Of Msus With Physical Examination Inflammatory mentioning

confidence: 99%

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

et al. 2018

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“…However, evidence exists that some patients with RA experience radiographic progression despite being in clinical remission [3]. This may be explained by the persistence of subclinical joint inflammation which can only be detected through sensitive imaging techniques such as MSUS and magnetic resonance imaging [4][5][6]. MSUS has been proved to be more sensitive than physical examination for the detection of synovitis [7].…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal ultrasound as a biomarker of remission – results from a one-year prospective study in patients with rheumatoid arthritis

2018

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Aims: To assess the role of musculoskeletal ultrasound (MSUS) as a biomarker of remission and to compare the rates of clinical and imaging remission in patients with rheumatoid arthritis (RA) on different types of treatment.Material and methods: One hundred and forty-one patients underwent physical and ultrasound examination at 5 visits (at baseline and after 1, 3, 6 and 12 months). Patients were divided into two groups according to the type of treatment, which involved synthetic (sDMARDs) and biologic (bDMARDs) disease-modifying antirheumatic drugs. Ultrasound assessment of the wrist, second and third metacarpophalangeal, second and third proximal interphalangeal joints, and the second and fifth metatarsophalangeal joints was performed on gray scale ultrasound (GSUS) and on power Doppler ultrasound (PDUS) (German US7-score). The rate of imaging and clinical remission (DAS28, SDAI, CDAI, and Boolean) was established. The percentage of patients in clinical remission with persistent PD signal was assessed.Results: In the sDMARDs group at month twelve, 43.6% of the patients achieved DAS28 remission, 5.1% – SDAI, 3.8% – CDAI, and 3.8% – Boolean remission. In the bDMARDs group 49.2% achieved DAS28 remission, 6.3% – SDAI, 4.8% – CDAI, and 4.8% – Boolean remission. Irrespective of which clinical index was applied, all patients in clinical remission had persistent synovial hypertrophy on GSUS. Synovial PD signal (PDUS score≥1) was detected in 77% and 71% of patients in DAS28 remission in the sDMARDs and bDMARDs group, respectively. Patients in SDAI, CDAI and Boolean remission in both treatment groups did not have а positive PD signal.Conclusions: There is persistence of synovitis both in patients on sDMARDs and bDMARDs in DAS28 clinical remission. This fact points to a discordance between DAS28 clinical remission and the imaging remission assessed by MSUS irrespective of the type of treatment. MSUS may be a feasible imaging method for the assessment of residual inflammation in daily rheumatology practice.

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“…This can be explained by the persistence of subclinical inflammation, found only by imaging modalities (Magnetic Resonance Imaging (MRI), MSUS). 16 There is evidence that the presence of a PD signal is a strong predictor of subsequent radiographic progression and a recent relapse in RA patients in remission. 17,18 In 2016, the International Task Group of experts in MSUS published a paper with 6 practical algorithms for the use of ultrasound in patients with RA in daily rheumatology practice.…”

Section: Msus As a Predictor Of Progression From Undifferentiated Artmentioning

confidence: 99%

Musculoskeletal Ultrasound in Rheumatology – New Horizons

Sapundzhieva

Karalilova

Batalov

2020

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Musculoskeletal ultrasound is a non-ionizing, cheap, reproducible, reliable imaging method, well accepted by the patients, that plays an important role in daily rheumatology practice. It can be used to assess joint and periarticular involvement, including tendon, bursae, enthesis, skin thickness, nails, lung and large vessels. Musculoskeletal ultrasound is more sensitive than physical examination, improves the diagnostic process, monitoring of treatment response, the accuracy of joint and soft tissue injections. It has proved its role as an important imaging modality in a number of rheumatic diseases – inflammatory joint diseases, systemic connective tissue diseases, large-vessel vasculitides, and degenerative and metabolic bone diseases.

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Persistence of subclinical sonographic joint activity in rheumatoid arthritis in sustained clinical remission

Abstract: We conclude that subclinical joint activity is long-lasting in RA joints in clinical remission, but attenuates over time. The latter conclusion is based on the observed shorter time duration from last clinical activity for strong compared with weaker sonographic signals.

Cited by 20 publications

References 9 publications

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

Musculoskeletal ultrasound as a biomarker of remission – results from a one-year prospective study in patients with rheumatoid arthritis

Musculoskeletal Ultrasound in Rheumatology – New Horizons

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Persistence of subclinical sonographic joint activity in rheumatoid arthritis in sustained clinical remission

Abstract: We conclude that subclinical joint activity is long-lasting in RA joints in clinical remission, but attenuates over time. The latter conclusion is based on the observed shorter time duration from last clinical activity for strong compared with weaker sonographic signals.

Cited by 20 publications

References 9 publications

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

Musculoskeletal ultrasound as a biomarker of remission – results from a one-year prospective study in patients with rheumatoid arthritis

Musculoskeletal Ultrasound in Rheumatology &ndash; New Horizons

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Musculoskeletal Ultrasound in Rheumatology – New Horizons