Factors influencing ultrasonographic remission in patients with rheumatoid arthritis.
The aim of this study was to define the ultrasonographic factors that indicate clinical remission in patients with RA. We enrolled a cohort of patients with RA in whom the disease had been in remission for at least 6 months. Musculoskeletal ultrasound (US) examination was used to evaluate the status of active synovitis, power Doppler (PD) signalling, and synovitis in the bilateral metacarpophalangeal; proximal interphalangeal; and radiocarpal, ulnocarpal, and intercarpal, compartments of the wrist. A total of 64 RA patients with a mean disease duration of 79.97 months were studied. Of all patients, 36% had ultrasonographic synovitis and 29% an increased PD signal from at least one joint. Delay in diagnosis was highly correlated with synovitis and PD synovitis (r = 0.55, p = 0.000; and r = 0.51, p = 0.001, respectively). A weak negative correlation was evident between synovitis, PD synovitis, tenosynovitis, PD tenosynovitis, and duration of clinical remission (respectively, r = -0.426, p = 0.000; r = -0.333, p = 0.007; r = -0.243, p = 0.050; and r = -0.247, p = 0.049). Upon multivariate logistic regression analysis, the duration of clinical remission and delay in diagnosis were the factors that most influenced ultrasonographic remission (OR 3.46, p = 0.046; OR 3.27, p = 0.016, respectively). Synovial inflammation may persist in RA patients exhibiting clinical remission. We found that US detected subclinical synovitis. The most important factors preventing ultrasonographic remission were a short duration of clinical remission and delay in diagnosis.
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Rheumatology, Sakarya University, Adapazarı, Sakarya, Turkey, drhharman@yahoo.com.
Halil
H
Harman
Ibrahim
I
Tekeoğlu
Nedim
N
Kaban
Sibel
S
Harman
D000068879:Adalimumab / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015331:Cohort Studies; D057210:Delayed Diagnosis; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D012074:Remission Induction; D000069283:Rituximab / Q000627:therapeutic use; D012720:Severity of Illness Index; D012460:Sulfasalazine / Q000627:therapeutic use; D013585:Synovitis / Q000000981:diagnostic imaging*; D013717:Tenosynovitis / Q000000981:diagnostic imaging*; D013997:Time Factors; D018608:Ultrasonography, Doppler
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D007555:Isoxazoles; D012460:Sulfasalazine; D000069283:Rituximab; D000068879:Adalimumab; D000077339:Leflunomide; D000068800:Etanercept; D008727:Methotrexate