title: Positive synovial vascularity in patients with low disease activity indicates smouldering inflammation leading to joint damage in rheumatoid arthritis: time-integrated joint inflammation estimated by synovial vascularity in each finger joint.
abstract: OBJECTIVE
  To investigate the relationship between synovial vascularity and joint damage progression in each finger joint of patients with RA under low disease activity during treatment with biologic agents.
  
  
  METHODS
  We studied 310 MCP and 310 PIP joints of 31 patients with active RA who were administered adalimumab (ADA) or tocilizumab (TCZ). Patients were examined with clinical and laboratory assessments. Power Doppler sonography was performed at baseline and at weeks 8, 20 and 40. Synovial vascularity was evaluated according to quantitative measurement. Hand and foot radiography was performed at baseline and at week 50.
  
  
  RESULTS
  Composite scores of the DAS with 28 joints and the Simplified Disease Activity Index (SDAI) were significantly decreased from baseline to week 8, being sustained at a low level by biologic agents during the observational period. MCP and PIP joints with positive synovial vascularity after week 8 showed more subsequent joint damage progression than joints without synovial vascularity throughout the follow-up. The changes in radiographic progression in these joints were independent of the sum of synovial vascularity from baseline to week 40 or the occasional occurrence of positive synovial vascularity.
  
  
  CONCLUSIONS
  Smouldering inflammation reflected by positive synovial vascularity under low disease activity was linked to joint damage. The damage progressed irrespective of the severity of positive synovial vascularity. Even with a favourable overall therapeutic response, monitoring of synovial vascularity has the potential to provide useful joint information to tailor treatment strategies. Trial registration. University Hospital Medical Information Network Clinical Trials Registry; http://www.umin.ac.jp/ctr/; UMIN000004476.
authors.affiliation: Hokkaido Medical Center for Rheumatic Diseases, 1-45, 3-Chome, 1-Jo, Kotoni, Nishi-ku, Sapporo 063-0811, Japan. jun.fukae@ryumachi-jp.com
authors.forename: Jun
authors.initials: J
authors.lastname: Fukae
authors.forename: Masato
authors.initials: M
authors.lastname: Isobe
authors.forename: Akemi
authors.initials: A
authors.lastname: Kitano
authors.forename: Mihoko
authors.initials: M
authors.lastname: Henmi
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Sakamoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Narita
authors.forename: Takeya
authors.initials: T
authors.lastname: Ito
authors.forename: Akio
authors.initials: A
authors.lastname: Mitsuzaki
authors.forename: Masato
authors.initials: M
authors.lastname: Shimizu
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Tanimura
authors.forename: Megumi
authors.initials: M
authors.lastname: Matsuhashi
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kamishima
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Atsumi
authors.forename: Takao
authors.initials: T
authors.lastname: Koike
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011859:Radiography; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000098:blood supply / Q000000981:diagnostic imaging*; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000068879:Adalimumab; C502936:tocilizumab