Session Type: Abstract Submissions (ACR)
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.
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.
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.
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.
A. L. Constantin,
A. G. Cantagrel,
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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/