Ultrasound-detected subclinical inflammation was better reflected by the disease activity score (DAS-28) in patients with suspicion of inflammatory arthritis compared to established rheumatoid arthritis.
Limited data are available about the ultrasound (US)-detected inflammatory features in patients with suspicion of inflammatory arthritis (S-IA) vs. established rheumatoid arthritis (RA). Our study aimed to assess if the presence of power Doppler (PD) can be predicted by a combination of clinical, laboratory and US parameters. We conducted a real-life, retrospective cohort study comparing clinical, laboratory and US parameters of 108 patients with established RA and 93 patients with S-IA. We propose a PD signal prediction model based on a beta-binomial distribution for PD variable using a mix of outcome measures. Patients with RA in clinical remission had significantly more active inflammation and erosions on US when compared with patients with S-IA with similar disease scores (p = 0.03 and p = 0.01, respectively); however, RA patients with different disease activity score (DAS-28) scores had similar PD scores (p = 0.058). The PD scores did not correlate with erosions (p = 0.38) or DAS-28 scores (p = 0.28) in RA patients, but they correlated with high disease activity in S-IA patients (p = 0.048). Subclinical inflammation is more common in patients with RA in clinical remission or with low disease activity than in patients with S-IA; therefore, US was more useful in assessing for true remission in RA rather than diagnosing IA in patients with low disease activity scores. This is the first study to propose a PD prediction model integrating several outcome measures in the two different groups of patients. Further research into validating this model can minimise the risk of underdiagnosing subclinical inflammation.
Department of Rheumatology, University College London Hospitals NHS Trust, 3rd Floor Central, 250 Euston Road, London, NW1 2PG, UK. c.ciurtin@ucl.ac.uk.
Coziana
C
Ciurtin
Department of Statistics, University College London, London, UK.
Karol
K
Wyszynski
Medical School, University College London, London, UK.
Robert
R
Clarke
Department of Rheumatology, Northwick Park Hospital, Harrow, UK.
Maria
M
Mouyis
Department of Rheumatology, University College London Hospitals NHS Trust, 3rd Floor Central, 250 Euston Road, London, NW1 2PG, UK.
Jessica
J
Manson
Department of Statistics, University College London, London, UK.
Giampiero
G
Marra
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D001175:Arthrography / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012074:Remission Induction; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*
D018501:Antirheumatic Agents
Inflammatory joint pains; Joint ultrasound; Prediction of power Doppler; Rheumatoid arthritis; Subclinical inflammation