title: Is there subclinical synovitis in patients with palindromic rheumatism in the intercritical period? a clinical and ultrasonographic study according to anticitrullinated protein antibody status.
abstract: OBJECTIVE
  To investigate the presence of subclinical synovitis by ultrasound (US) and the clinical phenotype in patients with palindromic rheumatism (PR) according to anticitrullinated protein antibody (ACPA) status.
  
  
  METHODS
  Fifty-four patients with PR were studied. Clinical, demographic, serological, and therapeutic characteristics were compared in ACPA-positive and ACPA-negative patients. US searching for synovial hypertrophy (SH) and power Doppler signal (PDUS) in 22 joints of the hands was performed in the intercritical period. The results were compared according to ACPA status and with a healthy control group (n = 30). In 10 patients, US was performed during the joint attack.
  
  
  RESULTS
  Most patients were female (63%) with a mean disease duration of 11.6 ± 10.7 years. Thirty-six patients (66.7%) were ACPA-positive. ACPA-positive patients had a shorter duration of attacks, a younger age, and less knee involvement at disease onset. US examination showed SH grade ≥ 1 in 79.6% of patients with PR and 50% of controls. Significant US results (SH ≥ 2 or PDUS) were observed in 2.7% and 1.4% of joints assessed and in 33% and 25.9% of patients with PR, respectively. Only 4 patients (7.4%) had US active synovitis (SH ≥ 2 plus PDUS) in at least 1 joint. US assessment showed no significant differences between ACPA-positive and ACPA-negative patients. PDUS was observed in 7 out of 10 patients during attacks.
  
  
  CONCLUSIONS
  Some differences emerged in the clinical phenotype of PR according to ACPA status. Most patients with PR do not have US subclinical synovitis in the intercritical period, even those who are ACPA-positive.
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cabrera-Villalba
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS.
authors.forename: Julio
authors.initials: J
authors.lastname: Ramirez
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS.
authors.forename: Georgina
authors.initials: G
authors.lastname: Salvador
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS.
authors.forename: Virginia
authors.initials: V
authors.lastname: Ruiz-Esquide
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS.
authors.forename: M Victoria
authors.initials: MV
authors.lastname: Hernández
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS.
authors.forename: José
authors.initials: J
authors.lastname: Inciarte-Mundo
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS.
authors.forename: José A
authors.initials: JA
authors.lastname: Gómez-Puerta
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cañete
authors.affiliation: From the Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain; Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Boston, Massachusetts, USA.S. Cabrera-Villalba, MD; J. Ramirez, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; G. Salvador, MD, PhD, Hospital Mútua de Terrassa; V. Ruiz-Esquide, MD, PhD; M.V. Hernández, MD, PhD; J. Inciarte-Mundo, MD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS; J.A. Gómez-Puerta, MD, PhD, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital; J.D. Cañete, MD, PhD; R. Sanmarti, MD, PhD, Arthritis Unit, Rheumatology Service, Hospital Clinic of Barcelona, IDIBAPS. sanmarti@clinic.cat.
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmarti
mesh_terms: D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood* / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000150:complications*; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D010641:Phenotype; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000473:pathology; D013585:Synovitis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000276:immunology; D014463:Ultrasonography
chemical_list: D000888:Antibodies, Anti-Idiotypic; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide
keywords: ANTICITRULLINATED PROTEIN ANTIBODIES; PALINDROMIC RHEUMATISM; SUBCLINICAL SYNOVITIS; ULTRASOUND