title: A reduced 12-joint ultrasound examination predicts lack of X-ray progression better than clinical remission criteria in patients with rheumatoid arthritis.
abstract: To study the predictive value of clinical remission definitions and ultrasound (US) examination on X-ray progression in rheumatoid arthritis (RA). This was an observational prospective multicenter 1-year follow-up cohort of RA patients with moderate disease activity (3.2 < DAS28 ≤ 5.1) who started anti-TNF therapy. DAS28ESR, DAS28CRP, SDAI, CDAI, and ACR/EULAR remission criteria were applied and reduced 12-joint US examination was performed at baseline and at 6 and 12 months. At baseline and month 12, radiographs of hands and feet were obtained in a subset of patients. A blind independent reader scored radiographs. X-ray progression was defined as Sharp van der Heijde change score >1 and no progression was defined as ≤0. 319 of 357 patients completed the study; patients had a mean (SD) age of 53.5 (13.1) years, with a disease duration of 7.5 (7.1) years. Laboratory, clinical, and US values significantly improved at month 6, except CRP, with additional improvement at month 12. Remission and low disease activity rates increased at follow-up. In the subset of 115 patients with radiological studies, clinical remission by any definition was not significantly associated with X-ray progression. Patients without PD signal at baseline and month 6 were a lower risk of X-ray progression than patients with PD signal, OR 0.197 (95% CI 0.046-0.861) and 0.134 (95% CI 0.047-0.378), respectively. Absence of PD signal, but not clinical remission predicts lack of X-ray progression. A feasible 12-joint US examination may add relevant information to RA remission criteria.
authors.affiliation: Rheumatology Department, Hospital Universitario La Paz, Pº de la Castellana 261, 28046, Madrid, Spain. eugenio.demiguel@gmail.com.
authors.forename: Eugenio
authors.initials: E
authors.lastname: de Miguel
authors.affiliation: Rheumatology Department, Hospital Universitario Miguel Servet, Saragossa, Spain.
authors.forename: Angela
authors.initials: A
authors.lastname: Pecondón-Español
authors.affiliation: Rheumatology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Castaño-Sánchez
authors.affiliation: Rheumatology Department, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Corrales
authors.affiliation: Rheumatology Department, Hospital de Navarra, Pamplona, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gutierrez-Polo
authors.affiliation: Rheumatology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodriguez-Gomez
authors.affiliation: Rheumatology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pinto-Tasende
authors.affiliation: Medical Department, AbbVie, Madrid, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Rivas
authors.affiliation: Rheumatology Department, Hospital La Fe, Valencia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Ivorra-Cortés
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000187:drug effects*; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012074:Remission Induction; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Composite indices; Disease activity; Progression; Remission; Rheumatoid arthritis; Structural damage; Ultrasonography; Ultrasound; X-ray