ASSOCIATION BETWEEN CLINICAL MANIFESTATIONS AND ULTRASONIC SIGNS OF INFLAMMATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune rheumatic disease characterized by chronic inflammation of the synovial membrane and a wide range of extra-articular (systemic) manifestations. The main goal of RA therapy is to achieve low disease activity or clinical remission. Power Doppler (PD) ultrasonography (USG) can significantly distinguish between active synovitis (hypervascularization of the synovial membrane) and inactive synovial proliferation. Objective: to investigate the association between the ultrasonic signs of active inflammation and the clinical and laboratory parameters of disease activity in patients with RA. Subjects and methods. The investigation included RA patients followed up at the V.A. Nasonova Research Institute of Rheumatology within the first Russian strategic study of pharmacotherapy for RA – REMARCA (Russian invEstigation of MethotrexAte and biologicals for eaRly aCtive Arthritis). A total of 105 RA patients (mean age 51 years), among whom 80% were rheumatoid factor (RF)-positive and 75% were anti-cyclic citrullinated peptide (ACCP)-positive, were examined. In all the patients, methotrexate (metoject, MEDAC, Germany) as the first diseasemodifying anti-rheumatic drug was subcutaneously injected in an initial dose of 10 mg/week with its rapid escalation up to 20–25 mg/week. Then the therapy was added by biologicals as the need arose. The clinical and laboratory parameters were analyzed immediately before and then 12, 24, 36, and 48 weeks following treatment. Therapeutic efficacy was evaluated using the European League Against Rheumatism (EULAR) criteria and activity indices (DAS28, CDAI, and SDAI). USG of eight articular areas (the wrist, second and third metacarpophalangeal, second and third proximal interphalangeal, second and fifth metatarsophalangeal articulations) in the hand and foot of the clinically dominant side was carried out in all the patients prior to treatment and at 12, 24, 36, and 48 weeks after its initiation. Semiquantitative gray-scale (GS) assessment and PD USG were performed according to the OMERACT criteria. Results and discussion. Weak correlations were found between USG parameters and DAS28, SDAI, and CDAI. After 48-week therapy, the signs of active synovitis were absent in 54 patients and persisted in 51, as evidenced by PD USG. The differences in clinical, laboratory, and ultrasonic parameters were analyzed in relation to USG evidence for active inflammation following 48 weeks of treatment. There were significant differences in GS and PD scores throughout the follow-up period; there were also differences in C-reactive protein levels at 12 and 48 weeks of therapy. No differences were found in clinical activity indices. Conclusion. The investigation provides support for the important role of USG in assessing the activity of synovitis in RA.