title: Ultrasound-detected tenosynovitis independently associates with patient-reported flare in patients with rheumatoid arthritis in clinical remission: results from the observational study STARTER of the Italian Society for Rheumatology.
abstract: OBJECTIVE
  This study aimed to estimate the prevalence of US-detected tenosynovitis in RA patients in clinical remission and to explore its clinical correlates.
  
  
  METHODS
  A total of 427 RA patients in clinical remission were consecutively enrolled from 25 Italian rheumatology centres. Tenosynovitis and synovitis were scored by US grey scale (GS) and power Doppler (PD) semi-quantitative scoring systems at wrist and hand joints. Complete clinical assessment was performed by rheumatologists blinded to the US results. A flare questionnaire was used to assess unstable remission (primary outcome), HAQ for functional disability and radiographic erosions for damage (secondary outcomes). Cross-sectional relationships between the presence of each US finding and outcome variables are presented as odds ratios (ORs) and 95% CIs, both crude and adjusted for pre-specified confounders.
  
  
  RESULTS
  The prevalence of tenosynovitis in clinical remission was 52.5% (95% CI 0.48, 0.57) for GS and 22.7% (95% CI 0.19, 0.27) for PD, while the prevalence of synovitis was 71.6% (95% CI 0.67, 0.76) for GS and 42% (95% CI 0.37, 0.47) for PD. Among clinical correlates, PD tenosynovitis associated with lower remission duration and morning stiffness while PD synovitis did not. Only PD tenosynovitis showed a significant association with the flare questionnaire [OR 1.95 (95% CI 1.17, 3.26)]. No cross-sectional associations were found with the HAQ. The presence of radiographic erosions associated with GS and PD synovitis but not with tenosynovitis.
  
  
  CONCLUSIONS
  US-detected tenosynovitis is a frequent finding in RA patients in clinical remission and associates with unstable remission.
authors.affiliation: Rheumatology Unit, Mauriziano Hospital, Turin.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Bellis
authors.affiliation: Epidemiology Unit, Italian Society for Rheumatology, Milan.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Scirè
authors.affiliation: Epidemiology Unit, Italian Society for Rheumatology, Milan.
authors.forename: Greta
authors.initials: G
authors.lastname: Carrara
authors.affiliation: Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena.
authors.forename: Antonella
authors.initials: A
authors.lastname: Adinolfi
authors.affiliation: Rheumatology Department, Luigi Sacco University Hospital, Milan.
authors.forename: Alberto
authors.initials: A
authors.lastname: Batticciotto
authors.affiliation: Rheumatology Department, S. Anna di Cona University Hospital, Ferrara.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bortoluzzi
authors.affiliation: Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cagnotto
authors.affiliation: Medicine Department, Istituti Clinici di Pavia e Vigevano, Pavia.
authors.forename: Marta
authors.initials: M
authors.lastname: Caprioli
authors.affiliation: Rheumatology Unit, A.O. Sant'Andrea, Rome.
authors.forename: Marco
authors.initials: M
authors.lastname: Canzoni
authors.affiliation: Rheumatology Unit, A.O.U.P. Santa Chiara, Trento.
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Cavatorta
authors.affiliation: Division and Chair of Rheumatology, Gaetano Pini Orthopaedic Institute, Milan.
authors.forename: Orazio
authors.initials: O
authors.lastname: De Lucia
authors.affiliation: Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena.
authors.forename: Valentina
authors.initials: V
authors.lastname: Di Sabatino
authors.affiliation: Rheumatology Department, Clinica Reumatologica, Università Policlinica delle Marche, Jesi.
authors.forename: Antonella
authors.initials: A
authors.lastname: Draghessi
authors.affiliation: Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena.
authors.forename: Georgios
authors.initials: G
authors.lastname: Filippou
authors.affiliation: Rheumatology Department, S. Anna di Cona University Hospital, Ferrara.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Farina
authors.affiliation: Rheumatology Unit, Infermi Hospital, Rimini.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Focherini
authors.affiliation: Rheumatology Unit, A.O.U. University Clinic Cagliari, Monserrato.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gabba
authors.affiliation: Rheumatology Department, Clinica Reumatologica, Università Policlinica delle Marche, Jesi.
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
authors.affiliation: Rheumatology Unit, Ospedale Civile Maggiore, Verona.
authors.forename: Luca
authors.initials: L
authors.lastname: Idolazzi
authors.affiliation: Rheumatology Unit, A.O.S. Maria della Misericordia, Perugia.
authors.forename: Filippo
authors.initials: F
authors.lastname: Luccioli
authors.affiliation: Rheumatology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Macchioni
authors.affiliation: Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano.
authors.forename: Marco Sergio
authors.initials: MS
authors.lastname: Massarotti
authors.affiliation: Rheumatology Unit, Moriggia-Pelascini Hospital, Gravedona.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mastaglio
authors.affiliation: Rheumatology Unit, Moriggia-Pelascini Hospital, Gravedona.
authors.forename: Luana
authors.initials: L
authors.lastname: Menza
authors.affiliation: A. Galateo Hospital, Rheumatology Unit, San Cesario di Lecce.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muratore
authors.affiliation: SC Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin.
authors.forename: Simone
authors.initials: S
authors.lastname: Parisi
authors.affiliation: Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena.
authors.forename: Valentina
authors.initials: V
authors.lastname: Picerno
authors.affiliation: Rheumatology Unit, A.O.U. University Clinic Cagliari, Monserrato.
authors.forename: Matteo
authors.initials: M
authors.lastname: Piga
authors.affiliation: Rheumatology Unit, Department of Medicine, DIMED, University of Padova, Padova.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ramonda
authors.affiliation: Rheumatology Unit, Bolzano Hospital, Bolzano.
authors.forename: Bernd
authors.initials: B
authors.lastname: Raffeiner
authors.affiliation: SS Immunoreumatologia, G. Bosco Hospital, Turin.
authors.forename: Daniela
authors.initials: D
authors.lastname: Rossi
authors.affiliation: Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Rheumatology Unit, P.O. Destra Secchia, Pieve di Coriano.
authors.forename: Paola
authors.initials: P
authors.lastname: Rossini
authors.affiliation: Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo.
authors.forename: Garifallia
authors.initials: G
authors.lastname: Sakellariou
authors.affiliation: DIM Sezione di Reumatologia, Policlinico Universitario di Bari.
authors.forename: Crescenzio
authors.initials: C
authors.lastname: Scioscia
authors.affiliation: Rheumatology Unit, A.O. Rummo di Benevento.
authors.forename: Carlo
authors.initials: C
authors.lastname: Venditti
authors.affiliation: Rheumatology Unit, A.O.U.P. Santa Chiara, Trento.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.affiliation: Rheumatology Unit, University of Florence, Florence.
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci-Cerinic
authors.affiliation: Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy annamaria.iagnocco1@gmail.com.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013585:Synovitis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D013717:Tenosynovitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: flare; remission; rheumatoid arthritis; tenosynovitis; ultrasound