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Ultrasound detection of subclinical synovitis in rheumatoid arthritis patients in clinical remission: a new reduced-joint assessment in 3 target joints

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

 

  1. Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
  2. ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy.
  3. Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
  4. Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
  5. ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy.
  6. ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy.
  7. Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
  8. ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy.
  9. Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
  10. ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy.
  11. Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
  12. Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Italy. annamaria.iagnocco1@gmail.com

CER10966
2018 Vol.36, N°6
PI 0984, PF 0989
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PMID: 29998842 [PubMed]

Received: 13/11/2017
Accepted : 26/02/2018
In Press: 14/06/2018
Published: 06/12/2018

Abstract

OBJECTIVES:
The ability of ultrasound (US) to identify subclinical joint inflammation in rheumatoid arthritis (RA) patients in remission has been already reported. Nonetheless, current studies present a lack of homogeneity in patient’s characteristics and number of joints assessed by US. The aim of this study was to identify a reduced set of target joints to be scanned in RA patients in clinical remission in order to detect subclinical synovitis.
METHODS:
Forty RA patients in clinical remission (DAS28 ≤2.6) for at least 3 months underwent an US examination of 18 joints: wrist, II-III-IV-V metacarpophalangeal (MCP) and II-III-IV-V metatarsophalangeal joints bilaterally. The presence of synovial hypertrophy (SH) and power-Doppler (PD) signal was registered following the OMERACT definitions and was graded according to a 4-point scale (0-3). Then, by applying a process of data reduction based on the frequency of joint involvement, a reduced assessment was obtained.
RESULTS:
Twenty (50%) subjects had at least one joint affected by active synovitis; 17.5% presented grade 1 PD and 32.5% grade 2 PD. The joints most frequently affected by active synovitis were the wrists (75%) and the II MCP joints (55%). After data reduction, the evaluation of 3 joints (both wrists and the II MCP of the dominant hand) obtained a sensitivity of 90% for the detection of subclinical synovitis.
CONCLUSIONS:
The US scan of 3 target joints showed a high sensitivity in detecting subclinical active synovitis in RA patients in clinical remission and can be feasible in the routine assessment of these patients.

Rheumatology Article