Abstract
Treat-to-target (T2T) strategy, aiming at clinical remission or low disease activity, has greatly improved the prognosis of rheumatoid arthritis (RA) since its institution in clinical practice in 2010. However, with the widespread application of ultrasound, the subclinical synovitis has been observed to be commonly present in RA patients in clinical remission. A systematic literature search and meta-analysis elated revealed an association between Power Doppler positivity and the risk of flare (OR 4.52, 95% CI 2.61-7.84, P<0.00001, I2=21%), the risk of progressive bone erosion on patient level (OR 12.80, 95% CI 1.29-126.81, P=0.03, I2=52%) and risk of progressive bone erosion on joint level (OR 11.85, 95% CI 5.01-28.03, P<0.00001, I2=0%). Furthermore, the treatment strategies targeting ultrasound remission in addition to clinical remission better controlled disease activity of RA patients and reduced flare during follow-up comparted to the treatment with clinical remission as the only target. Deeper clinical remission reflects the better control of subclinical synovitis under the ultrasound and could be an optimized treatment target in RA management.
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