Ultrasound abnormalities are widespread in patients with rheumatoid arthritis (RA) who are in clinical remission, with no significant association with clinical parameters in remission, according to study results published in Therapeutic Advances in Musculoskeletal Disease.
The study cohort included patients with an established diagnosis of RA who were enrolled in the Biomarkers of Remission in Rheumatoid Arthritis study, which evaluated disease-modifying antirheumatic drug (DMARD) cessation. Patients included this analysis were in clinical remission (Disease Activity Score 28 C-reactive protein [DAS28-CRP], <2.4) and receiving synthetic DMARDs at time of study entry. Patients from the Newcastle Early Arthritis Clinic who were DMARD-naive and undergoing clinical and ultrasonographic evaluation at first presentation with early active RA (DAS28-CRP >2.4) were included in the positive control group and those with seronegative noninflammatory arthralgia (NIA) were included in the negative control group.
Investigators examined the association between clinical parameters and total ultrasound scores with individual dependent variables, which included synovial power Doppler and greyscale, tenosynovial greyscale, and erosions.
Of 294 patients included in the study, 66 with RA were in clinical remission, 146 with early active RA were in the positive control group, and 82 were in the NIA negative control group. Synovial greyscale was common in patients in RA remission and occurred both in patients who did and did not meet the clinical remission criteria irrespective of whether it was the DAS28-CRP <2.4 (n=66) or the American College of Rheumatology/European League Against Rheumatism Boolean criteria (n=40). Other ultrasound abnormalities that occurred frequently included tenosynovial greyscale, erosions, and synovial power Doppler.
There was a significant association between swollen joint count and higher total synovial greyscale score (odds ratio [OR], 1.17; 95% CI, 1.08-1.26; P <.001) in the active RA group. In addition, the investigators observed a significant association between swollen joint count and higher total synovial power Doppler score (OR, 1.20; 95% CI, 1.12-1.30; P <.001). In the NIA group, there were no significant associations between swollen joint count and total synovial greyscale score or synovial power Doppler score. In the RA remission group, there were 6 significant variable-score associations (P <.05) in an adjusted model, but these associations were not significant in the adjusted analysis. In addition, there were no significant associations between the total synovial power Doppler score and clinical parameters in this group.
Study limitations included the reliance on a 7-point scan protocol, the small sample size, and the inclusion of only patients with established disease in the remission group.
Researchers concluded that ultrasound and clinical examination findings do not overlap “in RA remission, challenging the proposition of ultrasound-driven management strategies in this setting.”
Baker KF, Thompson B, Lendrem DW, Scadeng A, Pratt AG, Isaacs JD. Lack of association between clinical and ultrasound measures of disease activity in rheumatoid arthritis remission [published online May 11, 2020]. Ther Adv Musculoskelet Dis. doi:10.1177/1759720X20915322