title: Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse.
abstract: OBJECTIVE
  This study aimed to evaluate the usefulness of a systematic musculoskeletal ultrasonographic (US) assessment in the detection of residual disease activity in patients with early RA who achieved clinical remission.
  
  
  METHODS
  We prospectively studied 106 early RA patients receiving conventional DMARDs according to a disease activity score (DAS)-steered therapeutic protocol over a 24-month period. Standard evaluation included clinical, laboratory, functional and systematic (44 joints) US assessment. US indexes of grey scale (GS) and power Doppler (PD) synovitis were correlated with clinical evaluation, laboratory indexes and clinical outcome. Clinical remission was defined when DAS was <1.6 at two consecutive visits 3 months apart.
  
  
  RESULTS
  US examination was significantly more sensitive than clinical examination, both in active disease and in remission. In patients with an active disease, both clinical and US indexes correlated with CRP, whereas in remission only PD still remained significantly correlated. In clinical remission, 95% of the patients showed residual GS synovitis, and 41% of them showed a positive PD signal. Positive PD signal, even in a single joint, resulted the main predictor of relapse within 6 months, both in univariable and multivariable logistic regression analysis.
  
  
  CONCLUSIONS
  In a cohort of early RA patients treated with conventional DMARDs, US-GS can detect residual disease activity more sensitively than clinical examination both in active disease and in remission. Moreover, PD-positive synovial hypertrophy identifies an ongoing inflammation even during remission and predicts short-term relapse.
authors: Division of Rheumatology, Early Arthritis Clinic, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors: Carlo A
authors: CA
authors: Scirè
authors: Carlomaurizio
authors: C
authors: Montecucco
authors: Veronica
authors: V
authors: Codullo
authors: Oscar
authors: O
authors: Epis
authors: Monica
authors: M
authors: Todoerti
authors: Roberto
authors: R
authors: Caporali
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D042241:Early Diagnosis; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D013585:Synovitis / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler / Q000379:methods
chemical_list: D018501:Antirheumatic Agents