ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1049

The Prevalence of the Ultrasonographic Positive Power Doppler Synovitis Is High and Predicts the Risk of Relapse and Structural Progression in Rheumatoid Arthritis in Clinical Remission: A Systematic Literature Review and Meta Analysis

Huong Nguyen1, Adeline Ruyssen-Witrand1, Arnaud L. Constantin1, Violaine Foltz2, Frédérique Gandjbakhch3 and Alain G. Cantagrel1, 1Rheumatology, Purpan University Hospital, Toulouse, France, 2APHP, Pitié Salpétrière Hospital, Universite Paris 6, Paris, France, 3Department of Rheumatology, APHP, Pitié Salpétrière Hospital, Universite Paris 6, Paris, France

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Title: Imaging of Rheumatic Diseases: Magnetic Resonance Imaging, Computed Tomography and X-ray

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Ultrasonography (US) can detect synovitis in patients with rheumatoid arthritis (RA) more sensitively than clinical examination either in active disease or in remission.1, 2 There are many definitions of clinical remission, no consensus on US assessment of RA activity and the clinical implication of residual US synovitis is hotly debated.3, 4 This study is to assess the prevalence of residual US synovial hypertrophy (USGS+) and US power Doppler (PD) activity in patients in clinical remission and evaluate the predictive value of this residual synovitis in terms of relapse and structural progression.

Methods:

A systematic literature search was performed in the Medline, Embase and Rheumatology meeting databases up to 28 May 2012. The prevalence of USGS+, cold synovitis (USGS+/PD-), active synovitis (USGS+/PD+) and complete remission (USGS-/PD-) were collected taking into account the definition of clinical remission, the stage of RA (early or established disease) and the US examination method. A meta-analysis assessing the risk of relapse or structural progression in patients with USGS+/PD+ compared to other patients was performed calculating the odds ratio (ORMH) and 95% confidence interval [95%CI] with the Mantel-Haenszel method.

Results:

18 studies including 1528 patients were included in this systematic literature review. All of the studies used the OMERACT method for US scoring. The prevalence of US GS+, USGS+/PD-, USGS+/PD+ and USGS-/PD- were 81.8 %, 40%, 43% and 15.7%, respectively. USGS+ or USGS+/PD+ prevalence was comparable between the different definitions of clinical remission (DAS44, DAS28, SDAI, ACR 1981 or ACR/EULAR 2011) and between the different US examination methods (from 5 to 44 joints assessed). The prevalence of USGS+ and USGS+/PD+ was higher in the patients with established RA in comparison to patients with early RA (respectively 87% of USGS+ compared to 64%, p<0.001 and 45% of USGS+/PD+ compared to 34%, p<0.001). According to the results of the meta-analysis performed on 4 studies5-8 (including 178 patients) and 3 studies5, 9, 10 (including 173 patients), the presence of USGS+/PD+ was associated with an increased risk of relapse (ORMH[95%CI]=2.9, [1.5,5.9], p=0.002) and an increased risk of structural progression (OR[95%CI]= 12.8, [1.3, 126.8], p=0.03), respectively, over 1 to 2 years.

Conclusion:

The prevalence of residual US synovitis is high in patients in clinical remission. Residual USGS+/PD+ increase the risk of relapse and structural progression in these patients.

Disclosure:

H. Nguyen,
None;

A. Ruyssen-Witrand,
None;

A. L. Constantin,
None;

V. Foltz,
None;

F. Gandjbakhch,
None;

A. G. Cantagrel,
None.

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-prevalence-of-the-ultrasonographic-positive-power-doppler-synovitis-is-high-and-predicts-the-risk-of-relapse-and-structural-progression-in-rheumatoid-arthritis-in-clinical-remission-a-systematic/