Predicting Imaging Remission in Rheumatoid Arthritis: a Case-control Ultrasound Study

Area of Science:

• Rheumatology
• Medical Imaging
• Clinical Research

Background:

• Rheumatoid arthritis (RA) management aims for remission, but clinical remission doesn't always equate to absence of inflammation.
• Assessing subclinical inflammation is crucial for a comprehensive understanding of RA disease activity.

Purpose of the Study:

• To determine the achievement rate of imaging remission in RA patients who have achieved clinical remission.
• To identify clinical and laboratory characteristics associated with achieving imaging remission.

Main Methods:

• Ninety-seven RA patients with clinical remission (DAS28-ESR < 2.6) were assessed using Power Doppler ultrasonography (PDUS) on 16 joints and 2 tendons.
• Patients were categorized into imaging remission (PDUS negative) and non-remission (PDUS positive) groups.
• Clinical and laboratory data were compared between the groups.

Main Results:

• The imaging remission rate was 51.5%; 48.5% of patients showed persistent synovitis on PDUS, most commonly in the radiocarpal joint.
• PDUS-positive patients exhibited higher evaluator global assessment (EGA), clinical disease activity index, and simplified clinical disease activity index scores.
• Patients in imaging remission had lower pain scores, less NSAID use, higher rheumatoid factor (RF), and anti-cyclic citrullinated peptide levels.

Conclusions:

• A significant proportion of RA patients in clinical remission do not achieve imaging remission, indicating persistent subclinical inflammation.
• Lower EGA scores and higher RF levels are associated with achieving imaging remission in RA patients.
• PDUS is valuable for assessing subclinical synovitis in RA patients who have attained clinical remission.