Background/Purpose: To determine clinical, sonographic and immunological biomarkers predicting structural damage progression at 12 months of follow-up as measured by Magnetic Resonance Imaging (MRI) in a population of Rheumatoid Arthritis (RA) patients in clinical remission.

Methods: We included patients with RA in clinical remission defined as disease activity score of 28 joints (DAS28)-erythrocyte sedimentation rate (ESR) <2.6 for > 6 months. Serum cytokines and angiogenic mediators, Ultrasound scans of both hands and knees and MRI of dominant hand were performed at baseline and after 12 months.

Results: Forty-two patients completed the follow-up. 78% female, aged (median) 54 years; disease duration was 93 months; 85% ACPA positive; C-reactive protein (CRP) was 0.10 mg/dl; ESR 9 mm/h and DAS28-ESR: 2.00. Twelve (28%) patients were taking oral prednisone, 34 (81%) conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), and 20 (47%) biological therapies. At baseline, 45% fulfilled criteria for ultrasound defined active synovitis (UdAS) (synovial hyperplasia>2+PD signal). Significant associations between baseline RAMRIS, body mass index (BMI), disease duration, prednisone treatment, lack of csDMARDs and the presence of UdAS (but not PD alone) with RAMRIS progression after 12 months were found. Serum levels of calprotectin were significantly correlated with bone edema progression.

Conclusion: We identified clinical and sonographic biomarkers of RAMRIS progression after 12 months of follow-up in patients with RA in clinical remission. The concept of ultrasound active synovitis, defined as the simultaneous occurrence of relevant synovial hyperplasia and PD is associated with RAMRIS progression after 12 months.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-sonographic-and-immunological-biomarkers-of-ramris-progression-in-ra-patients-in-clinical-remission-a-prospective-study-with-12-months-of-follow-up/