title: Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the DAS28 and/or the new ACR/EULAR RA remission definitions: results of an observational cohort study.
abstract: OBJECTIVE
  The primary aim of the study was to evaluate whether rheumatoid arthritis (RA) patients considered to be in remission according to clinical criteria sets still had persisting ultrasound (US) synovitis. We further intended to evaluate the capacity of our US score to discriminate between the patients with a clinically active disease versus those in remission.
  
  
  METHODS
  This is an observational study nested within the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) rheumatoid arthritis cohort. A validated US score (SONAR score) based on a semi-quantitative B-mode and Doppler (PwD) score as part of the regular clinical workup by rheumatologists in different clinical settings was used. To define clinically relevant synovitis, the same score was applied to 38 healthy controls and the 90st percentile was used as cut-off for 'relevant' synovitis.
  
  
  RESULTS
  Three hundred and seven patients had at least one US examination and concomitant clinical information on disease activity. More than a third of patients in both DAS28 and ACR/EULAR remission showed significant gray scale synovitis (P=0.01 and 0.0002, respectively) and PwD activity (P=0.005 and 0.0005, respectively) when compared to controls. The capacity of US to discriminate between the two clinical remission groups and patients with active disease was only moderate.
  
  
  CONCLUSIONS
  This observational study confirms that many patients considered to be in clinical remission according the DAS and the ACR/EULAR definitions still have residual synovitis on US. The prognostic significance of US synovitis and the exact place of US in patients reaching clinical remission need to be further evaluated.
authors: RHU/CHUV de Lausanne, avenue Pierre-Decker 5, 1010 Lausanne, Switzerland. Electronic address: Pascal.zufferey@chuv.ch.
authors: Pascal
authors: P
authors: Zufferey
authors: Rheumatology Inselspital, Bern, Switzerland.
authors: Burkhard
authors: B
authors: Möller
authors: Rheumatology/HUG, Geneva, Switzerland.
authors: Laure
authors: L
authors: Brulhart
authors: Bethesda Spital AG, Basel, Switzerland.
authors: Giorgio
authors: G
authors: Tamborrini
authors: SCQM, Zurich, Switzerland.
authors: Almut
authors: A
authors: Scherer
authors: Rheumatology/HUG, Geneva, Switzerland.
authors: Axel
authors: A
authors: Finckh
authors: OsteoRheuma, Bern, Switzerland.
authors: Hans-Rudolf
authors: HR
authors: Ziswiler
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D018501:Antirheumatic Agents
keywords: Remission; Rheumatoid arthritis; Score; US