Should the Ultrasound of Hands be a Component of Rheumatoid Arthritis Remission Criteria?

Abstract

Introduction: The definition of remission in Rheumatoid Arthritis (RA) is still difficult to determine. An ultrasound of the hands may be important in helping confirm clinical remission. Objective: This study’s aim was to evaluate the interest in using an ultrasound of the hands to confirm clinical remission, as well as comparing the various remission scores (DAS 28 VS, DAS 28 CRP, and SDAI) and the ultrasound data, in order to deduce the most accurate score to confirm this remission. Methods: In this prospective monocentric study, we studied patients with rheumatoid arthritis in clinical remission, according to DAS 28 VS, for at least 3 months without corticosteroid therapy. An ultrasound mode B / Doppler of the hands was taken by an experienced rheumatologist, involving 22 joints: wrists, Metacarpophalangeal (MCP) joints and proximal interphalangeal joints (PPI) bilaterally. Results: Fifty-one patients were included. They were classified in remission according to DAS 28 VS as well as DAS 28 CRP, whereas the remission according to SDAI was achieved in 66.7% of our patients. Synovial hypertrophy and power Doppler were present in respectively 65% and 25% of the patients. SDAI was the most accurate score to confirm RA remission (p < 0.003). Conclusion: SDAI appears to be the most appropriate score for the definition of remission in rheumatoid arthritis, but despite the use of the latter, ultrasound synovitis may still be present. Further work deserves to be done to clarify the value of ultrasound evaluation in the definition of RA remission.

Validity of Remission Criteria in Rheumatoid Arthritis Compared to Ultrasound-Defined Remission

“…Indeed, some authors do not currently support the routine use of US assessment as part of an enhanced Treat-to-Target strategy recommended by EULAR. [20][21][22] Based on the results of the ARCTIC trial US tight control strategy did not show additional effect compared to the conventional tight control strategy. 22 The results of the TaSER study are in line with these findings.…”

Anti–Cyclic Citrullinated Peptide Antibodies Correlate to Ultrasound Synovitis in Rheumatoid Arthritis Better Than C-Reactive Protein

“… 7 However, the optimal utilization of US in routine clinical practice for patients with established RA remains uncertain. 3 , 8 , 9 …”

“…7 However, the optimal utilization of US in routine clinical practice for patients with established RA remains uncertain. 3,8,9 The objective assessment of disease activity in RA includes erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), the markers of inflammation. In addition, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are not only indicators for the diagnosis, but also predictors of disease outcome.…”

“…In addition, US has a role in guiding treatment for treat-to-target in RA 7 . However, the optimal utilization of US in routine clinical practice for patients with established RA remains uncertain 3,8,9 …”