Abstract
Regarding the persistence of subclinical synovitis, the concept of ultrasound remission has been proposed in addition to clinical remission. The present study aims to explore whether ultrasound remission has predictive value and ultrasound remission at which time point has predictive value for good structural outcome. Collagen-induced arthritis (CIA) was induced in 32 rats by immunizing with bovine type II collagen. Twenty-four CIA rats were treated with rhTNFR:Fc, and 8 rats were left untreated. Ultrasonography was performed to assess synovial hypertrophy, power Doppler (PD) signal, and bone erosion of the ankle joints of both hindpaws every week following the booster immunization. In the treated group, the scores for synovial hypertrophy, PD signal and bone erosions decreased from baseline to the end. Synovial hypertrophy, PD signal, and bone erosion at baseline were not significantly associated with good structural outcome. Ultrasound remission from 4 to 6 weeks after treatment was significantly associated with good outcome and had the highest area under the curve, sensitivity, specificity, and positive and negative predictive values. Therefore, we conclude that ultrasound remission from 4 to 6 weeks after treatment has a high value for predicting good structural outcome in CIA rats.
Highlights
Rheumatoid arthritis (RA) is the most common inflammatory joint disorder that causes progressive joint damage and functional disability[1]
Of the 48 joints in the treated collagen-induced arthritis (CIA) group, synovial hypertrophy was observed in 44 joints at baseline and in 29 joints at the end point, power Doppler (PD) signals were observed in 25 joints at baseline and in 8 joints at the end point, and bone erosions were observed in 42 joints at baseline and in 27 joints at the end point
Of the 16 joints in the untreated CIA group, synovial hypertrophy was observed in 16 joints at baseline and in 16 joints at the end point, PD signals were observed in 6 joints at baseline and in 9 joints at the end point, and bone erosions were observed in 16 joints at baseline and in 16 joints at the end point (Table 1)
Summary
Rheumatoid arthritis (RA) is the most common inflammatory joint disorder that causes progressive joint damage and functional disability[1]. Brown et al carried out the first study to demonstrate the dissociation between clinical remission and radiographic progression in RA patients, and demonstrate a direct association between synovitis, as detected by musculoskeletal ultrasound (MSKUS) and radiographic progression in individual joints[5]. A large body of evidence suggests that the persistence of subclinical synovitis detected by MSKUS is associated with a high risk of radiological progression[6,7,8]. The recommendations of European League Against Rheumatism (EULAR) suggest that ultrasound can detect inflammation, which predicts subsequent joint damage, even when clinical remission is present and can be used to assess persistent inflammation[11]. No study has explored ultrasound remission at which time point could predict good structural outcome. The present study aims to determine whether ultrasound remission has predictive value and ultrasound remission at which time point has predictive value for good structural outcome
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