Structural deterioration of finger joints with ultrasonographic synovitis in rheumatoid arthritis patients with clinical low disease activity.
OBJECTIVE
In this study we investigated the relationship between synovial vascularity (SV) and structural alteration of finger joints in patients with RA and long-term sustained clinical low disease activity (CLDA).


METHODS
RA patients with CLDA of >2 years (minimum 1 year of CLDA for study entry plus 1 year of observation) were analysed. Quantitative SV values were sequentially measured in each finger joint using power Doppler ultrasonography (0, 8, 20 and 52 weeks). Radiological progression of local finger joints was evaluated according to the Genant-modified Sharp score (0-52 weeks).


RESULTS
Of the 25 patients enrolled, 15 patients were finally analysed after excluding 10 patients who failed to maintain CLDA during the observational period. Changes in radiological progression of MCP and PIP joints with positive SV were significantly greater than those in joints with negative SV. Joint space narrowing (JSN) was strongly related to structural alteration of finger joints. In joints with positive SV, changes in structural alteration did not relate to total SV values, which reflect total exposure to inflammation in an observational period.


CONCLUSIONS
Even in patients with a long period of CLDA, finger joints with positive SV showed structural alteration, especially in the progression of JSN.


BACKGROUND
University Hospital Medical Information Network Clinical Trials Registry, http://www.umin.ac.jp/ctr/, UMIN000007305.
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan. jun.fukae@ryumachi-jp.com.
Jun
J
Fukae
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Masato
M
Isobe
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Akemi
A
Kitano
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Mihoko
M
Henmi
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Fumihiko
F
Sakamoto
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Akihiro
A
Narita
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Takeya
T
Ito
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Akio
A
Mitsuzaki
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Masato
M
Shimizu
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Kazuhide
K
Tanimura
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Megumi
M
Matsuhashi
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Tamotsu
T
Kamishima
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Tatsuya
T
Atsumi
Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Faculty of Health Science, Hokkaido University and Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Takao
T
Koike
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D005384:Finger Joint / Q000098:blood supply / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000098:blood supply / Q000000981:diagnostic imaging; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000209:etiology; D018608:Ultrasonography, Doppler
D018501:Antirheumatic Agents
clinical remission; power Doppler; rheumatoid arthritis; treat to target; ultrasonography