The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound.
OBJECTIVE
To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA).


METHODS
Patients with RA.


METHODS
Prospective, 2-year follow-up.


METHODS
Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2.


METHODS
Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis.


RESULTS
Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36-2.98) p<0.001 versus 1.61 (1.06-2.45) p=0.026 versus 1.75 (1.18-2.58) p=0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR=2.16 (1.16-4.02) p=0.015 and 3.50 (1.77-6.95) p<0.001 for US-GS and US-PD and 2.79 (1.35-5.76) p=0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression.


CONCLUSIONS
This study confirms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.
Hopital Cochin, Rheumatology, Clinique de Rhumatologie B, Groupe Hospitalier Cochin, Paris 75014, France. m.doug@cch.aphp.fr
Maxime
M
Dougados
Valérie
V
Devauchelle-Pensec
Jean François
JF
Ferlet
Sandrine
S
Jousse-Joulin
Maria-Antonietta
MA
D'Agostino
Marina
M
Backhaus
Jacques
J
Bentin
Gérard
G
Chalès
Isabelle
I
Chary-Valckenaere
Philip
P
Conaghan
Richard J
RJ
Wakefield
Fabien
F
Etchepare
Frédéric
F
Etcheparre
Philippe
P
Gaudin
Walter
W
Grassi
Désirée van der
Dv
Heijde
Xavier
X
Mariette
Esperanza
E
Naredo
Marcin
M
Szkudlarek
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D018608:Ultrasonography, Doppler / Q000592:standards*