RESEARCH - Should imaging be a component of RA remission criteria?

[Guest guest]

Ann Rheum Dis doi:10.1136/ard.2010.134445

Extended report

Clinical and epidemiological research

Should imaging be a component of rheumatoid arthritis remission

criteria? A comparison between traditional and modified composite

remission scores and imaging assessments

Benazir Saleem1,2, K Brown3,4, Helen Keen1,2, Sharmin Nizam1,2,

Jane Freeston1,2, Wakefield1,2, Zunaid Karim1,2, Mark

Quinn3,4, Hensor1,2, Philip G Conaghan1,2, Emery1,2

1Section of Musculoskeletal Disease, Leeds Institute of Molecular

Medicine, University of Leeds, Leeds Teaching Hospital NHS Trust,

Chapel Allerton Hospital, Leeds, UK

2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK

3Hull and York Medical School, University of York, York, UK

4Department of Rheumatology, York Hospital NHS Foundation Trust, York, UK

Accepted 2 December 2010

Published Online First 17 January 2011

Objectives

Patients can fulfil clinical criteria for remission, yet still have

evidence of synovitis detectable clinically and by ultrasound, and

this is associated with structural damage. Stricter remission criteria

may more accurately reflect true remission (no synovitis). This

hypothesis was examined by studying patients using more stringent

thresholds for clinical remission and determining their levels of

ultrasound synovitis.

Methods Rheumatoid arthritis patients with a disease activity score in

28 joints (DAS28) ≤2.6 for at least 6 months were classified using

standard and more stringent DAS28 and simplified disease activity

index (SDAI) remission thresholds and the corresponding clinical and

ultrasound imaging measures of synovitis recorded.

Results 128 patients (all DAS28 <2.6, median DAS28 1.70) receiving

either disease-modifying antirheumatic drugs alone (n=66) or with a

tumour necrosis factor blocker (n=62) were recruited. Of the 640

imaged joints, 5% had moderate or severe power Doppler (PD) activity,

8% were clinically swollen and 1% tender. In patients fulfilling

DAS28, American College of Rheumatology or SDAI remission criteria,

moderate or severe PD activity was present in 21%, 15% and 19%,

respectively. More stringent DAS28 and SDAI criteria reduced the mean

number of swollen and tender joints (p<0.001) but not the percentage

of patients with PD activity: 32 patients had a DAS28 <1.17 but eight

(25%) had significant PD activity.

Conclusion Using more stringent remission criteria resulted in reduced

signs and symptoms of inflammation, but the percentage of joints with

PD activity was not reduced, even in those without signs or symptoms.

These data suggest that clinical criteria are sufficiently insensitive

to detect low but clinically relevant levels of inflammation

accurately.

http://ard.bmj.com/content/early/2011/01/12/ard.2010.137695.abstract?papetoc

Not an MD