title: Can routine clinical measures predict ultrasound-determined synovitis and remission in rheumatoid arthritis patients?
abstract: OBJECTIVE
  The purpose of this study was to determine if routine clinical measures can predict the presence and severity of ultrasound synovitis in rheumatoid arthritis (RA) patients.
  
  
  METHODS
  Bilateral 1-5 MCP (metacarpopharangeal) and wrist joints were examined using power Doppler (PD) ultrasound (US). Correlations between PD scores and routine clinical measures of RA - swollen joint count (SJC), tender joint count, patient's global assessment (GA), physician's GA, CRP, ESR, MMP-3, RF and anti-CCP antibody - were determined and used to identify significant predictors of PD score. Clinical measures were then compared between two groups (patients with and without PD) and analysed using multiple logistic regression, to derive a model that predicted the absence of PD signals.
  
  
  RESULTS
  SJC was the most significant predictor of PD score (R2 = 0.4566, p value <0.0001), but was an inadequate predictor of PD signal remission. However, the combination of Steinbrocker's stage I or II (odds ratio [OR] 9.23, p=0.0049), SJC=0 in 1-5 MCP and wrist joints on both sides (OR 6.60, p=0.0039), and SDAI (or CDAI) remission (OR 5.06, p=0.0450) had a positive predictive value of 100%, predicting the absence of PD signals in all study patients meeting the 3 criteria.
  
  
  CONCLUSIONS
  PD score and absence of PD signals can be predicted using routine clinical measures. When used in combination, Steinbrocker's stage, SJC and SDAI (or CDAI) can estimate disease activity and identify patients likely to have synovitis and requiring US.
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan. tnemoto@juntendo.ac.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nemoto
authors.forename: Michihiro
authors.initials: M
authors.lastname: Ogasawara
authors.forename: Yuko
authors.initials: Y
authors.lastname: Matsuki
authors.forename: Go
authors.initials: G
authors.lastname: Murayama
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamada
authors.forename: Nagachika
authors.initials: N
authors.lastname: Sugisaki
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ando
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minowa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kon
authors.forename: Kurisu
authors.initials: K
authors.lastname: Tada
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsushita
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaji
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D013585:Synovitis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D015415:Biomarkers