title: Ultrasound-detected activity in rheumatoid arthritis on methotrexate therapy: Which joints and tendons should be assessed to predict unstable remission?
abstract: The aim of the study was to investigate the predictive value of different reduced joint ultrasound (US) assessments of synovitis and tenosynovitis in relation to unstable remission in a cohort of rheumatoid arthritis (RA) patients on methotrexate therapy. Forty-seven RA patients (38 women, 9 men), being treated with methotrexate (MTX), in clinical remission as judged by their consultant rheumatologist were evaluated for disease activity according to the Disease Activity Score (DAS) 28 at baseline and 6 months. Sustained remission and unstable remission were defined according to the baseline and 6-month DAS28 and changes in RA therapy during the follow-up. Each patient underwent at baseline a B-mode and power Doppler (PD) assessment of 44 joints and 20 tendons/tendon compartments by a rheumatologist blinded to the clinical and laboratory data. B-mode synovial hypertrophy (SH), synovial PD signal, B-mode tenosynovitis, and Doppler tenosynovitis were scored 0-3. The presence and index of synovial PD signal in 44 joints [odds ratio (OR) 8.21 (p = 0.016) and OR 2.20 (p = 0.049), respectively] and in 12 joints [OR 5.82 (p = 0.041) and OR 4.19 (p = 0.020), respectively], the presence of SH in wrist and MCP joints [OR 4.79 (p = 0.045)], and the presence of synovial PD signal in wrist-MCP-ankle-MTP joints [OR 4.62 (p = 0.046)] were predictors of unstable remission. The 12-joint or wrist-hand-ankle-MTP US assessments can predict unstable remission in RA patients in apparent clinical remission being treated with MTX.
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain. iustinajanta@yahoo.com.
authors.forename: Iustina
authors.initials: I
authors.lastname: Janta
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: Valor
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: De la Torre
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Lina
authors.initials: L
authors.lastname: Martínez-Estupiñán
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Nieto
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Juan Gabriel
authors.initials: JG
authors.lastname: Ovalles-Bonilla
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Martínez-Barrio
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Bello
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hinojosa
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Montoro
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Carlos Manuel
authors.initials: CM
authors.lastname: González
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: López-Longo
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Indalecio
authors.initials: I
authors.lastname: Monteagudo
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Carreño
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Complutense University, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
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*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging* / Q000187:drug effects*; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D013585:Synovitis / Q000000981:diagnostic imaging / Q000188:drug therapy; D013710:Tendons / Q000000981:diagnostic imaging* / Q000187:drug effects*; D013717:Tenosynovitis / Q000175:diagnosis / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: Doppler; Remission; Rheumatoid arthritis; Synovitis; Tenosynovitis; Ultrasound