Rheumatoid Arthritis Relapse and Remission - Advancing Our Predictive Capability Using Modern Imaging

Area of Science:

• Rheumatology
• Medical Imaging
• Inflammation

Background:

• Clinical remission is achievable for most rheumatoid arthritis (RA) patients.
• Subclinical inflammation, detected by ultrasound and MRI, is frequent in patients achieving clinical remission.
• This subclinical synovitis is associated with joint damage progression and disease flare risk.

Purpose of the Study:

• To evaluate the significance of subclinical inflammation in rheumatoid arthritis (RA) patients.
• To question the sole reliance on clinical composite scores for treatment targets.
• To explore the role of imaging in guiding treatment adjustments for RA patients in remission.

Main Methods:

• Assessment of subclinical inflammation using ultrasound and magnetic resonance imaging (MRI).
• Analysis of the association between subclinical synovitis and disease outcomes.
• Review of studies attempting to treat subclinical inflammation.

Main Results:

• Subclinical synovitis is common in RA patients in clinical remission.
• Subclinical inflammation correlates with structural damage and flare risk.
• Treating subclinical inflammation may lead to stricter remission and better function but increases adverse events.
• Overall benefit of incorporating imaging goals into treat-to-target strategies is not documented.

Conclusions:

• Subclinical synovitis indicates incomplete inflammation suppression in rheumatoid arthritis (RA).
• Current evidence does not support routine use of imaging goals in treat-to-target strategies.
• Ultrasound and MRI may assist in decisions regarding drug tapering or discontinuation in RA patients in remission.