title: Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The aims of this study were to assess the prevalence of US-detected residual synovitis in patients with RA in clinical remission (CR) and evaluate its predictive value for relapse and structural progression.
  
  
  METHODS
  We performed a systematic literature search of Medline, Embase and rheumatology meeting databases from 1 January 2001 to 28 May 2012. The prevalence of US grey-scale (USGS) signals (synovial hypertrophy or joint effusion) and power Doppler (PD) signals were collected, taking into account CR definitions [44-joint DAS (DAS44), 28-joint DAS (DAS28), SDAI, ACR 1981 or ACR/European League Against Rheumatism 2011], stage of RA (early or long-standing) and US examination (from 5 to 44 joints assessed). A meta-analysis assessing the risk of relapse or structural progression in patients with synovitis involved the Mantel-Haenszel method.
  
  
  RESULTS
  We included 19 studies of 1618 patients, 1369 in remission. The prevalence of USGS positive (USGS+), USGS+/PD negative (PD-), USGS+/PD positive (PD+) and USGS negative (USGS-/PD- was 84%, 41%, 44% and 15%, respectively. The prevalence of USGS+ or USGS+/PD+ was comparable among CR definitions and US methods. The prevalence of USGS+ and USGS+/PD+ was greater for long-standing than early RA (P < 0.001). Meta-analyses of five studies (271 patients), three studies (173 patients) and two studies (798 joints) revealed an association of USGS+/PD+ and risk of relapse [odds ratio (OR) 3.2 (95% CI 1.8, 5.9), P = 0.0001, I(2) = 0%] and structural progression in individual patients [OR 9.13 (95% CI 1.1, 74.3), P = 0.04, I(2) = 43%] and joints [OR 6.95 (95% CI 3.4, 13.9), P < 0.0001, I(2) = 6%] over 1-2 years.
  
  
  CONCLUSIONS
  US-detected residual synovitis is frequent and predicts the risk of relapse and structural progression in RA patients with CR.
authors.affiliation: Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France.
authors.forename: Huong
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. adruyssen@hotmail.com.
authors.forename: Adeline
authors.initials: A
authors.lastname: Ruyssen-Witrand
authors.affiliation: Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Gandjbakhch
authors.affiliation: Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Constantin
authors.affiliation: Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France.
authors.forename: Violaine
authors.initials: V
authors.lastname: Foltz
authors.affiliation: Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D018450:Disease Progression; D014943:Global Health; D006801:Humans; D015995:Prevalence; D012008:Recurrence; D012074:Remission Induction; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D014463:Ultrasonography
chemical_list: D018501:Antirheumatic Agents
keywords: meta-analysis; prevalence; prognostic factors; remission; rheumatoid arthritis; synovitis; systematic review; ultrasound