Validity of Doppler subclinical synovitis as an activity marker associated with bone erosions in rheumatoid arthritis patients during clinical remission

Abstract

IntroductionClinical remission is a realistic goal in rheumatoid arthritis (RA) patients. Doppler signals-synovitis may also be considered predictive of clinical flare-ups in RA. Objective: The aim of this study was to detect subclinical synovitis and erosions by musculoskeletal ultrasound (MSUS) in RA patients with clinical remission and free from physical synovitis. Materials and methods41 RA patients were studied who achieved clinical remission for at least 6months proved by clinical disease activity index (CDAI) and DAS28 without tender neither swollen joints. MSUS of 22 joint done for each patient, the data of gray scale (GSUS) and color Doppler ultrasound (CDUS) graded on a semi-quantitative scale from 0 to 3. ResultsThe percentage of RA patients with subclinical synovitis present in at least one joint with CDUS⩾1, and CDUS⩾2 were 70.7% and 29.2% respectively. The results of CDUS were significantly lower with biologic agents compared to patients on conventional disease modifying anti-rheumatic drugs (DMARDs) alone (p=0.01). There was a strong association between CDUS synovitis and MSUS bone erosions (p<0.00001). ConclusionDoppler detected subclinical synovitis could be considered a reliable marker to appraise disease activity in RA patients compared to DAS28 and CDAI, in associated joint destruction secondary to erosions.