title: Relation of Doppler ultrasound synovitis versus clinical synovitis with changes in native complement component levels in rheumatoid arthritis patients treated with biologic disease-modifying anti-rheumatic drugs.
abstract: OBJECTIVE
  The complement system plays a fundamental role in mediating the activity of rheumatoid arthritis (RA). Biologic therapy can reduce native complement component levels and its activation. We aimed to study the relation of Doppler ultrasound (US) synovitis versus clinical synovitis with changes in native complement component levels in RA patients on biologic therapy.
  
  
  METHODS
  This was a cross-sectional study. Ninety-seven consecutive patients with RA on biologic therapy for at least 3 months were recruited. Clinical, laboratory and Doppler US assessments were performed. The Disease Activity Score in 28 joints (DAS28), Simplified Disease Activity Index (SDAI) and a 12-joint US assessment were carried out. Synovitis was semiquantitatively scored in B-mode and power Doppler (PD) mode.
  
  
  RESULTS
  A significant decrease in native complement (i.e. C3 and C4) and C-reactive protein (CRP) levels was observed. This was highly significant for C3 decrease (p<0.0005), and C4 decrease (p<0.0005). Synovitis detected by PD US showed significant negative association with C3 change (p<0.008), where patients with higher C3 change were more likely to have PD US inactive status on assessment.
  
  
  CONCLUSIONS
  Our results suggested that disease inactive status determined by PD US but not by clinical assessment can be related with decrease in complement in RA patients treated with biologic therapy.
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Maria
authors: M
authors: Montoro Alvarez
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; and Department of Medicine (Rheumatology Unit), Selayang Hospital, Selangor, Malaysia.
authors: Ong Yew
authors: OY
authors: Chong
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Iustina
authors: I
authors: Janta
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Carlos
authors: C
authors: González
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Javier
authors: J
authors: López-Longo
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Indalecio
authors: I
authors: Monteagudo
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Larissa
authors: L
authors: Valor
authors: Department of Social Psychology and Methodology, Faculty of Psychology, Autónoma University, Madrid, Spain.
authors: Jesús
authors: J
authors: Garrido
authors: Department of Medicine (Rheumatology Unit), Selayang Hospital, Selangor, Malaysia.
authors: Ing Soo
authors: IS
authors: Lau
authors: Department of Medicine (Rheumatology Unit), Selayang Hospital, Selangor, Malaysia.
authors: Azmillah
authors: A
authors: Rosman
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Esperanza
authors: E
authors: Naredo
authors: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Luis
authors: L
authors: Carreño
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003167:Complement Activation / Q000187:drug effects; D003165:Complement System Proteins / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012074:Remission Induction; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000276:immunology; D013585:Synovitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D015415:Biomarkers; D018836:Inflammation Mediators; D003165:Complement System Proteins; D002097:C-Reactive Protein