RESEARCH - Presence of significant synovitis in RA patients with DMARD-induced clinical remission

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Presence of significant synovitis in rheumatoid arthritis patients

with disease-modifying antirheumatic drug–induced clinical remission:

Evidence from an imaging study may explain structural progression

A. K. Brown1, M. A. Quinn1, Z. Karim1, P. G. Conaghan1, C. G.

fy2,†, E. Hensor1, R. J. Wakefield1, P. J. O'Connor3, P.

Emery1,*Article first published online: 28 NOV 2006

Arthritis & Rheumatism

Volume 54, Issue 12, pages 3761–3773, December 2006

Author Information

1Chapel Allerton Hospital, University of Leeds, Leeds, UK

2Synarc, San Francisco, California

3Leeds General Infirmary, Leeds, UK

Abstract

Objective

More timely and effective therapy for rheumatoid arthritis (RA) has

contributed to increasing rates of clinical remission. However,

progression of structural damage may still occur in patients who have

satisfied remission criteria, which suggests that there is ongoing

disease activity. This questions the validity of current methods of

assessing remission in RA. The purpose of this study was to test the

hypothesis that modern joint imaging improves the accuracy of

remission measurement in RA.

Methods

We studied 107 RA patients receiving disease-modifying antirheumatic

drug therapy who were judged by their consultant rheumatologist to be

in remission and 17 normal control subjects. Patients underwent

clinical, laboratory, functional, and quality of life assessments. The

Disease Activity Score 28-joint assessment and the American College of

Rheumatology remission criteria, together with strict clinical

definitions of remission, were applied. Imaging of the hands and

wrists using standardized acquisition and scoring techniques with

conventional 1.5T magnetic resonance imaging (MRI) and ultrasonography

(US) were performed.

Results

Irrespective of which clinical criteria were applied to determine

remission, the majority of patients continued to have evidence of

active inflammation, as shown by findings on the imaging assessments.

Even in asymptomatic patients with clinically normal joints, MRI

showed that 96% had synovitis and 46% had bone marrow edema, and US

showed that 73% had gray-scale synovial hypertrophy and 43% had

increased power Doppler signal. Only mild synovial thickening was seen

in 3 of the control subjects (18%), but no bone marrow edema.

Conclusion

Most RA patients who satisfied the remission criteria with normal

findings on clinical and laboratory studies had imaging-detected

synovitis. This subclinical inflammation may explain the observed

discrepancy between disease activity and outcome in RA. Imaging

assessment may be necessary for the accurate evaluation of disease

status and, in particular, for the definition of true remission.

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Read the full article here:

http://onlinelibrary.wiley.com/doi/10.1002/art.22190/full

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