title: Persistence of subclinical sonographic joint activity in rheumatoid arthritis in sustained clinical remission.
abstract: BACKGROUND
  Sonographic assessment, measuring grey scale (GS) and power Doppler (PD) signals, is a sensitive tool for the evaluation of inflammatory joint activity in patients with rheumatoid arthritis (RA). We evaluated the persistence of PD and GS signals in previously clinically active RA joints that have reached a state of continuous clinical inactivity.
  
  
  METHODS
  We performed sonographic imaging of 22 joints of the hands of patients with RA, selected all joints without clinical activity but showing ongoing sonographic signs of inflammation, and evaluated the time from last clinical joint activity.
  
  
  RESULTS
  A total of 90 patients with RA with 1980 assessed joints were included in this study. When comparing the mean time from clinical swelling, we found a significantly longer period of clinical inactivity in joints showing low sonographic activity (mean±SD time from swelling of 4.1±3.2 vs 3.1±2.9 years for PD1 vs PD≥2, p=0.031 and 4.5±3.4 vs 3.3±3.2 years for GS1 vs GS≥2, p≤0.0001).
  
  
  CONCLUSIONS
  We conclude that subclinical joint activity is long-lasting in RA joints in clinical remission, but attenuates over time. The latter conclusion is based on the observed shorter time duration from last clinical activity for strong compared with weaker sonographic signals.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Gärtner
authors.affiliation: Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Alasti
authors.affiliation: Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Supp
authors.affiliation: Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Mandl
authors.affiliation: Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria.
authors.forename: J S
authors.initials: JS
authors.lastname: Smolen
authors.affiliation: Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Aletaha
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D005384:Finger Joint / Q000098:blood supply / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000098:blood supply / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging; D012074:Remission Induction; D012720:Severity of Illness Index; D013585:Synovitis / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler; D014955:Wrist Joint / Q000098:blood supply / Q000000981:diagnostic imaging*
chemical_list: D018501:Antirheumatic Agents
keywords: Disease Activity; Rheumatoid Arthritis; Ultrasonography