title: Predictive value of bone destruction and duration of clinical remission for subclinical synovitis in rheumatoid arthritis patients.
abstract: OBJECTIVE
  Treatment for rheumatoid arthritis (RA) should aim to achieve full remission. The aim of this study was to investigate predictors of persistent subclinical synovitis and whether longer clinical remission is effective in reducing subclinical synovitis.
  
  
  METHODS
  Forty-four RA patients who achieved DAS28ESR clinical remission for at least 3 months were enrolled in this study and underwent ultrasound examination of 22 joints (bilateral proximal interphalangeal joints, metacarpophalangeal joints, and wrists); bilateral hand X-ray; and blood examination. The severity of synovial effusion, synovial hypertrophy, and blood flow were semi-quantitatively graded from 0 to 3 using gray-scale (GS) and power Doppler (PD) modes.
  
  
  RESULTS
  Among patients with DAS28ESR-defined clinical remission, 59.1% (26/44) demonstrated residual synovitis (≥ PD1) in at least one joint. Genant-modified total Sharp score (TSS) demonstrated the highest statistical difference between patients with and without residual subclinical synovitis (p = 0.0057), and full remission was only observed in patients with low TSS. A nonsignificant trend for decreased residual synovitis with longer sustained clinical remission was also observed (p = 0.724).
  
  
  CONCLUSIONS
  Residual synovitis can persist during clinical remission, particularly in patients with progressive bone destruction. Early treatment and longer sustained clinical remission prior to bone destruction are critical for full remission.
authors.affiliation: Department of Internal Medicine (I), Osaka Medical College.
authors.forename: Nao
authors.initials: N
authors.lastname: Tokai
authors.forename: Michihiro
authors.initials: M
authors.lastname: Ogasawara
authors.forename: Misa
authors.initials: M
authors.lastname: Gorai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Matsuki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamada
authors.forename: Go
authors.initials: G
authors.lastname: Murayama
authors.forename: Nagachika
authors.initials: N
authors.lastname: Sugisaki
authors.forename: Takuya
authors.initials: T
authors.lastname: Nemoto
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ando
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minowa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kon
authors.forename: Kurisu
authors.initials: K
authors.lastname: Tada
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsushita
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaji
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.forename: Shigeki
authors.initials: S
authors.lastname: Makino
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012074:Remission Induction / Q000379:methods; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000209:etiology; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: Bone destruction; Rheumatoid arthritis; Subclinical synovitis; Ultrasound