In patients with rheumatoid arthritis (RA) who have achieved clinical remission, the presence of ultrasound-detected tenosynovitis and joint synovitis is an independent risk factor for flare, according to results published in the Annals of the Rheumatic Diseases.

The results also show that clinicians can use musculoskeletal ultrasound to monitor patients with RA that is in clinical remission and to assist in decision making.

The Sonographic Tenosynovitis/Arthritis Assessment in Rheumatoid Arthritis Patients in Remission study included participants at 25 Italian centers who had RA that was in clinical remission (n=361). The participants underwent complete clinical assessment and power Doppler ultrasound evaluation of wrist, metacarpophalangeal joints, proximal interphalangeal joints, and synovial tendons of the hands and wrists at baseline, at 6 months, and at 12 months.


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During 12 months of follow-up, 30.1% (n=98) of participants had a disease flare. The concurrent presence of Power Doppler-positive tenosynovitis and joint synovitis predicted disease flare, with an odds ratio (OR) of 2.75 (95% CI, 1.45-5.20) after crude analyses and an OR of 2.09 (95% CI, 1.06-4.13) after adjusted analyses.

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The researchers also found that ultrasound variables did not predict the worsening of function or radiographic progression. They note that ultrasound was able to predict disease flares at 12 months but not at 6 months.

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Reference

Filippou G, Sakellariou G, Scire CA, et al. The predictive role of ultrasound-detected tenosynovitis and joint synovitis for flare in patients with rheumatoid arthritis in stable remission. Results of an Italian multicentre study of Italian Society for Rheumatology Group for Ultrasound: the STARTER study. [published online June 9, 2018]. Ann Rheum Dis. doi:10.1136/annrheumdis-2018-213217