Abstract Introduction: Clinical remission is a realistic goal in rheumatoid arthritis (RA) patients.
Doppler signals-synovitis may also be considered predictive of clinical flare-ups in RA. Objective:
The aim of this study was to detect subclinical synovitis and erosions by musculoskeletal ultrasound
(MSUS) in RA patients with clinical remission and free from physical synovitis.
Materials and methods: 41 RA patients were studied who achieved clinical remission for at least
6 months proved by clinical disease activity index (CDAI) and DAS28 without tender neither swollen
joints. MSUS of 22 joint done for each patient, the data of gray scale (GSUS) and color Doppler
ultrasound (CDUS) graded on a semi-quantitative scale from 0 to 3.
Results: The percentage of RA patients with subclinical synovitis present in at least one joint with
CDUS P 1, and CDUS P2 were 70.7% and 29.2% respectively. The results of CDUS were significantly
lower with biologic agents compared to patients on conventional disease modifying antirheumatic
drugs (DMARDs) alone (p=0.01). There was a strong association between CDUS synovitis
and MSUS bone erosions (p< 0.00001).
Conclusion: Doppler detected subclinical synovitis could be considered a reliable marker to
appraise disease activity in RA patients compared to DAS28 and CDAI, in associated joint destruction
secondary to erosions. |
