RESEARCH - An explanation for the apparent dissociation between clinical remission and continued structural deterioration in RA

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Arthritis Rheum. 2008 Sep 29;58(10):2958-2967.

An explanation for the apparent dissociation between clinical

remission and continued structural deterioration in rheumatoid

arthritis.

Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, fy CG, Hensor

E, Wakefield RJ, O'Connor PJ, Emery P.

University of Leeds, and Chapel Allerton Hospital, Leeds, UK.

OBJECTIVE: Achieving remission is the aim of treatment in rheumatoid

arthritis (RA). This should represent minimal arthritis activity and

ensure optimal disease outcome. However, we have previously

demonstrated a high prevalence of imaging-detected synovial

inflammation in RA patients who were in clinical remission. The

purpose of this study was to evaluate the long-term significance of

subclinical synovitis and its relationship to structural outcome.

METHODS: We studied 102 RA patients receiving conventional treatment

who had been judged by their consultant rheumatologist to be in

remission, as well as 17 normal control subjects. Subjects underwent

clinical, laboratory, functional, and quality of life assessments over

12 months. In addition to standard radiography of the hands and feet,

imaging of the hands and wrists was performed with musculoskeletal

ultrasonography (US) and conventional 1.5T magnetic resonance imaging

(MRI) at baseline and 12 months, using validated acquisition and

scoring techniques.

RESULTS: Despite their being in clinical remission, 19% of the

patients displayed deterioration in radiographic joint damage over the

study period. Scores on musculoskeletal US synovial hypertrophy, power

Doppler (PD), and MRI synovitis assessments in individual joints at

baseline were significantly associated with progressive radiographic

damage (P = 0.032, P < 0.001, and P = 0.002, respectively).

Furthermore, there was a significant association between the

musculoskeletal US PD score at baseline and structural progression

over 12 months in totally asymptomatic metacarpophalangeal joints (P =

0.004) and 12 times higher odds of deterioration in joints with

increased PD signal (odds ratio 12.21, P < 0.001).

CONCLUSION: Subclinical joint inflammation detected by imaging

techniques explains the structural deterioration in RA patients in

clinical remission who are receiving conventional therapy. Our

findings reinforce the utility of imaging for the accurate evaluation

of disease status and the prediction of structural outcome.

PMID: 18821687

http://www.ncbi.nlm.nih.gov/pubmed/18821687

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