Background/Purpose:

Power Doppler ultrasonography (PDUS) is sensitive for detecting synovitis in patients with rheumatoid arthritis (RA).  We aimed to clarify the association of PDUS findings with routine clinical indices and its usefulness in detecting disease remission.

Methods:

We studied 72 RA patients with mean age 62.5 years, mean disease duration 5.6 years, and 61% women.  We examined 22 joints including bilateral wrists, metacarpo-phalangeal, and proximal interphalangeal joints using PDUS to evaluate the presence of inflammation with scoring from 0 to 3 according to the signal intensity of each joint, and the sum score (ranging from 0 to 66) was defined as “PDUS score”.  Clinical disease activity score/indices including DAS28CRP, SDAI, and CDAI were also recorded.  Clinical remission was defined according to the following criteria: DAS28CRP < 2.3, SDAI ≤ 3.3, CDAI ≤ 2.8, and Boolean-based definition.  Sonographic remission was defined by absence of PDUS signals.

Results:

Mean values ± SD of DAS28CRP, SDAI, and CDAI were 3.3±1.5, 18.8 ±15.0, and 17.3±13.5, respectively.  Mean values ± SD of PDUS score was 6.2 ± 6.3 and significantly correlated with all three clinical disease activity score/indices; among them the correlation with SDAI was strongest (r=0.77, p<0.001).  PDUS score was more significantly correlated with swollen joint counts (r=0.73), patient global assessment (GA) (r=0.77), or evaluator GA (r=0.85), than with tender joint counts (r=0.50) or serum CRP (r=0.61).  Remission was observed in 17 (24%) patients by DAS28CRP, in 11 (15%) by SDAI, in 12 (17%) by CDAI, and in 14 (19%) by Boolean-based definition, respectively.  Sonographic remission was observed in 9 (13%) patients.  In 36–59% of the patients satisfying clinical remission criteria, the PDUS signals were detected indicating the presence of synovitis (Table 1).  Values of DAS28CRP, SDAI, and CDAI of patients with sonographic remission were 1.3, 1.7, and 1.9, respectively.

Table 1. Distribution of patients with absence and presence of PDUS signals for patients with clinical disease remission defined by DAS28CRP, SDAI, CDAI, and Boolean-based criteria.

Conclusion:

PDUS is useful for evaluating RA disease activity, is exceedingly sensitive, and is a useful method for detecting “pure” RA disease remission.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-rheumatoid-arthritis-disease-activity-by-power-doppler-ultrasonography-association-with-routine-clinical-indices-and-its-usefulness-in-detecting-remission/