Ultrasound Remission Research Articles

Gastrointestinal Ultrasound Can Predict Endoscopic Activity inCrohn's Disease.

To explore the ability of gastrointestinal ultrasound (GIUS) to separate patients in endoscopic remission from patients with active disease in a heterogeneous hospital cohort with Crohn's disease (CD). 145 CD patients scheduled for ileocolonoscopy were prospectively included. The endoscopic disease activity was quantified using the Simple Endoscopic Score for Crohn's disease (SES-CD), and mucosal healing was strictly defined as SES-CD = 0. Ultrasound remission was defined as wall thickness < 3 mm (< 4 mm in the rectum). Additionally, SES-CD was compared to color Doppler, Harvey Bradshaw's index (HBI), C-reactive protein (CRP) and calprotectin. 23 patients were examined by two investigators for interobserver assessment. 102 had active disease and 43 patients were in remission. GIUS yielded a sensitivity of 92.2 % and a specificity of86 % for wall thickness and a sensitivity of 66.7 % and a specificity of 97.7 % for color Doppler. The sensitivity and specificity were 34.3 % and 88.4 %, respectively, for HBI, 35.7 % and 82.9 %, respectively, for CRP and 55.9 % and 82.1 %, respectively, for calprotectin. The interobserver analysis revealed excellent agreement for wall thickness (k = 0.90) and color Doppler (k = 0.91) measurements. GIUS has a high sensitivity for detecting endoscopic activity. Accordingly, bowel ultrasound has the potential to reduce the number of routine ileocolonoscopies in patients with CD.

P234 Characterisation of human synovial tissue dendritic cells in rheumatoid arthritis patients

Abstract Background Dendritic cells (DCs) direct immune responses against pathogens while maintaining tolerance to self-antigens. However, their aberrant activation can lead to autoimmunity and inflammation. DCs consist of two subtypes: plasmacytoid and myeloid DCs. Recently, single-cell sequencing has revealed complex heterogeneity within myeloid DCs. These cells can be divided into CD141pos (DC1), DC2 defined as CD1highCD163neg and DC3 defined as CD1clowCD163high. In addition, a population of CD1cnegCD141negCD16pos (DC4), which share some gene expression with CD16pos monocytes, has been identified. To date, most studies of RA investigated DC precursors in circulation or synovial fluid (SF). However, DCs perform their functions within lymphoid or peripheral tissue. Therefore, in this study, we sought to characterise myeloid DC subsets in synovial tissue (ST) with the prospect of better understanding their role in driving autoimmunity in RA. Methods We developed a flow sorting strategy to characterise the phenotype of distinct myeloid DC subsets in multiple biological compartments (PB, SF, and ST). Ultrasound-guided ST biopsies (RA n = 9; Psoriatic arthritis n = 3 with active disease) were digested with liberase prior to analysis. PB DCs (RA n = 19, Psoriatic arthritis n = 16, healthy donors n = 12), and SF DC (n = 3) were used as comparators. ST, SF and PB DCs were sorted then microRNA, pro-inflammatory and regulatory cytokine expression analysed by amplified qPCR. To evaluate the role of miR-155 in RA CD1cpos DC activation, CD1cpos cells were computationally sub-setted from a scRNAseq synovial dataset comparing synovial tissues of healthy individuals (n = 4) with patients with active RA (n = 7) and those in sustained clinical and ultrasound remission (n = 7). To elucidate the role of miR-155, CD1cpos DC from RA patients (n = 10) were sorted then transfected with miR-155 mimic or control mimic and the cytokines expression and produced were evaluated using quantitative RT-PCR and Luminex, respectively. Results Our data revealed that whilst all myeloid DCs subsets can be present in inflamed RA synovium they occur with variable frequencies. CD1cpos (DC2/3) being the most abundant, followed by CD16pos DCs (DC4), whilst CD141pos DCs (DC1) occur in low numbers or are absent. CD1cpos DC sorted from RA ST express high levels of epigenetic regulators of inflammatory response miR-155, IL-6, TNF-a and IL-23 as compared to circulating cells.Unsupervised clustering of synovial CD1c cells identified 4 separate clusters including a distinctive miR155 positive CD1c cluster in RA patients. These cells showed significantly higher expression of pro-inflammatory cytokines and co-stimulatory molecules compared to other synovial CD1c clusters. Overexpression of miR-155 in CD1cpos leads to increased production of TNF-a and IL-23. Conclusion Our data show that miR-155 is strongly implicated as an epigenetic regulator of the pro-inflammatory synovial CD1cpos DCs sub-cluster and contributes to exacerbating RA. Disclosures A. Elmesmari None. L. MacDonald None. D. Vaughan None. B. Tolusso None. L. Bui None. M. Gigante None. F. Federico None. G. Ferraccioli None. E. Gremese None. I. B McInnes None. S. Alivernini None. M. Kurowska-Stolarska None.

P143 Gastrointestinal ultrasound is an accurate marker for endoscopic activity in Crohn’s disease

Abstract Background Treatment goals for Crohn’s disease (CD) have changed from symptom control to objective endpoints, preferably endoscopic remission. However, as the relative invasiveness of ileocolonoscopy limits repeated examinations, a surrogate marker of endoscopic remission is needed. Gastrointestinal ultrasound (GIUS) is accurate in detecting CD, and we aimed to explore its ability to distinguish between patients with active disease from patients in remission. Methods One hundred and forty-five CD patients scheduled for ileocolonoscopy were prospectively included. The endoscopic disease activity was quantified using the Simple Endoscopic Score for Crohn’s disease (SES-CD), and endoscopic remission was strictly defined as SES-CD=0. Ultrasound remission was defined as wall thickness &amp;lt;3 mm (&amp;lt;4 mm in the rectum). Additionally, SES-CD was compared with colour Doppler, Harvey Bradshaw’s index (HBI), C-reactive protein (CRP) and calprotectin. Twenty-three patients were examined by two investigators for interobserver assessment. Results 102 had active disease and 43 patients were in remission. GIUS yielded a sensitivity of 92.2% and specificity of 86% for wall thickness and sensitivity 66.7% and specificity 97.7% for colour Doppler. For HBI sensitivity was 34.3% and specificity 88.4%, CRP sensitivity 35.7% and specificity 82.9% and calprotectin sensitivity 55.9 % and specificity 82.1%. The interobserver analysis revealed excellent agreement (k=0.90). Conclusion GIUS has a high sensitivity for detecting endoscopic activity, but poorer specificity. In a hospital cohort of patients with Crohn’s disease, the number of invasive procedures could be reduced by reserving ileocolonoscopy for patients with a normal ultrasound for identification of patients in remission.

P492 Use of bowel ultrasound to assess disease activity in Crohn’s disease patients after induction therapy with infliximab

Abstract Background Objective goals are needed to guide patient management and assess treatment efficacy in patients with Crohn’s disease (CD). Bowel ultrasound (US) is a widely available, non-invasive and inexpensive technique increasingly being used in these patients. The use of bowel wall thickness (BWT) has been proved to be an accurate measure for assessing disease activity and response to therapy. Recent studies show a rapid improvement of BWT after 3-month of therapy. Our aim was to evaluate BWT variation after induction therapy with infliximab (IFX) in CD patients and correlate BWT with clinical and laboratory parameters. Methods Prospective cohort multicentre study including patients with active CD starting IFX therapy. Clinical disease activity was assessed using the Harvey–Bradshaw index (HBI). C-reactive protein (CRP) and faecal calprotectin (FC) were measured both at week 0 and after induction therapy (week 14), and infliximab trough levels (ITL) were measured at week 14. Bowel ultrasound was performed at week 0 and 14, BWT from the worst segment was selected for analysis. Abnormal BWT was defined has higher than 3mm in any bowel segment. Results We included 10 patients with CD (80% males; median age 29 (21–64) years). According to Montreal classification, most patients were A2 (7/10), had ileocolonic disease (L1 20%; L2 20%; L3 60%) and an inflammatory phenotype (B1 60%; B2 20% and B3 20%). Most patients were anti-TNF therapy naive (80%), and combination therapy was used in 80%. Before IFX (week 0) median HBI was 2 (IQR 1.75–5.25), CRP 1.10 mg/dl (IQR 0.65–3.50) and FC 802 μg/g (IQR 324–1336). The terminal ileum was the most affected segment identified by the USA (5/10), followed by ascending colon (2/10) descending colon (2/10) and sigmoid colon (1/10). Median BWT was 4.6 mm (IQR 3.6–6.4). After induction therapy (week 14), all patients were in clinical remission (HBI&amp;lt;5) except for one in whom IFX dose was increased to 10 mg/kg. Laboratory remission (CRP &amp;lt; 0.5 mg/dl and FC &amp;lt; 250 μg/g) was present in 50% of patients. US response (measured by a reduction in BWT of at least 0.5 mm) was observed in 70% of patients, with US remission (normalisation of BWT in the most affected segment) in 30%. At week 14, 70% of patient had ITL &amp;gt; 3 μg/ml. Median BWT at week 14 was higher in patients with ITL &amp;lt; 3 μg/ml (6.25 vs. 2.98 mm, p = 0.048). Conclusion The majority of our patients showed a US response (reduction in BWT) after 14 weeks of infliximab, suggesting that reduction in BWT could be an early marker of response to therapy. US evaluation after induction therapy can be a helpful tool to monitor disease activity and guide patient management in CD patients in our daily practice.

Rheumatoid Arthritis: Defining Clinical and Ultrasound Deep Remission.

The prognosis of patients with rheumatoid arthritis (RA) has improved substantially in the last two decades due to the appearance of biological therapies, but above all, due to the improvement in the strategy and management of the disease. Our goal in RA should be to achieve remission, or in its absence, the lowest inflammatory activity. Achieving remission will prevent from structural and functional damage highly associated with RA itself. Clinical remission is defined as the absence of significant signs and symptoms of inflammatory disease activity, as well as the abrogation of any signs of systemic inflammation. Currently, there are some controversies about remission. Which is the real remission? Which remission criteria should be used and when? Does clinical remission mean ultrasound remission? In the present review, we try to answer and put some light into it, focusing on clinical and ultrasound deep remission.

Ultrasound remission can predict future good structural outcome in collagen-induced arthritis rats

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.

Defining remission in rheumatoid arthritis: does it matter to the patient? A comparison of multi-dimensional remission criteria and patient reported outcomes.

In a cross-sectional study, we evaluated the prevalence of 'multi-dimensional remission' (MDR) and its component parameters, assessed using objective measures in a cohort of RA patients in treatment-induced DAS28-remission, and their relationship with patient-reported outcome measures. We sought to confirm the feasibility and face validity of the MDR construct, providing a platform for future longitudinal studies in which its clinical utility might be further established. 605 patients were selected from an inflammatory arthritis register using DAS28(CRP)<2.6. Demographic, clinical and patients reported outcomes (PRO) data were collected. Ultrasound power doppler synovitis (n = 364) and T-cell subsets (n = 297) were also measured. Remission using clinical parameters was defined as: tender and swollen joint count (TJC/SJC) and CRP all ⩽1; ultrasound remission: total power doppler = 0 and T cell remission: positive normalized naïve T-cell frequency. MDR was defined as the achievement of all three dimensions. Overall, only 53% (321/605) of the patients achieved clinical parameters, failures being mainly due to raised CRP (52%), TJC (28)>1 (37%) or SJC (28)>1 (16%). 211/364 (58%) of patients achieved ultrasound remission and 193/297 (65%) patients showed T-cell remission. Complete data were available for 231 patients. MDR was observed in only 35% and was associated with the best (lower) PRO scores (all P ⩽ 0.05 vs non-MDR) when compared with the other definitions of remission assessed. The MDR rate was similar in early and established RA patients on b-DMARDs; however, it was lower in established RA patients who received multiple cs-DMARDs (P = 0.011). In this study, MDR, which may represent a state closer to normality, was found to occur in about a third of DAS28-remission patients and was associated with better patient-reported outcome measures. MDR could be a novel optimal treatment target, notably from a patient's perspective. The relevance of these findings needs further assessment.

Overweight/obesity affects histological features and inflammatory gene signature of synovial membrane of Rheumatoid Arthritis

Overweight/obesity influence disease burden and clinical outcome of Rheumatoid Arthritis (RA). The impact of overweight/obesity on synovial tissue (ST) inflammation is largely unknown. Here, we investigated the histological and transcriptional signature of ST obtained from RA in different disease phases (disease onset, failure to first-line conventional DMARDs and in sustained clinical and ultrasound remission) finding that overweight/obese DMARDs naive RA showed higher likelihood of follicular synovitis, higher IHC scores for sublining inflammatory cells (CD68+, CD21+ and CD20+) and higher IL-1RA plasma levels than normal weight RA. Regardless to the synovitis pattern, overweight/obese DMARDs naive RA showed a worse clinical response to “Treat-to-target” (T2T) than normal weight RA at 6 and 12 months follow-up. Conversely, MTX-IR RA did not show significant differences in synovial inflammation based on BMI category. Overweight/obese RA in stable clinical and US remission showed higher degree of residual synovitis in terms of sublining CD68+, CD20+ cells and lining and sublining CD3+ compared to normal weight RA. Finally, gene expression profile analysis revealed that ST of overweight/obese DMARDs naive RA is enriched by CCL3 and MyD88 compared to normal weight RA in sustained disease remission, the latter correlating with BMI and IHC scores for synovial CD68+ cells. These findings suggest that indeed overweight/obese RA show higher degree of synovitis at disease onset and after remission achievement that influences the response rate to T2T and should be considered within the management of patients with RA.

Predicting drug-free remission in rheumatoid arthritis: A prospective interventional cohort study

BackgroundMany patients with rheumatoid arthritis (RA) achieve disease remission with modern treatment strategies. However, having achieved this state, there are no tests that predict when withdrawal of therapy will result in drug-free remission rather than flare. We aimed to identify predictors of drug-free remission in RA. MethodsThe Biomarkers of Remission in Rheumatoid Arthritis (BioRRA) Study was a unique, prospective, interventional cohort study of complete and abrupt cessation of conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs). Patients with RA of at least 12 months duration and in clinical and ultrasound remission discontinued DMARDs and were monitored for six months. The primary outcome was time-to-flare, defined as disease activity score in 28 joints with C-reactive protein (DAS28-CRP) ≥ 2.4. Baseline clinical and ultrasound measures, circulating inflammatory biomarkers, and peripheral CD4+ T cell gene expression were assessed for their ability to predict time-to-flare and flare/remission status by Cox regression and receiver-operating characteristic (ROC) analysis respectively. Results23/44 (52%) eligible patients experienced an arthritis flare after a median (IQR) of 48 (31.5–86.5) days following DMARD cessation. A composite score incorporating five baseline variables (three transcripts [FAM102B, ENSG00000228010, ENSG00000227070], one cytokine [interleukin-27], one clinical [Boolean remission]) differentiated future flare from drug-free remission with an area under the ROC curve of 0.96 (95% CI 0.91–1.00), sensitivity 0.91 (0.78–1.00) and specificity 0.95 (0.84–1.00). ConclusionWe provide proof-of-concept evidence for predictors of drug-free remission in RA. If validated, these biomarkers could help to personalize immunosuppressant withdrawal: a therapy paradigm shift with ensuing patient and economic benefits.

Absence of correlation between DAS28-ESR, DAS28-CRP, SDAI, CDAI and ultrasound scoring in patients with rheumatoid arthritis in remission

Objective: Several composite scores (28-joints Disease Activity Score (DAS28), Simplified/Clinical Disease Activity Index (SDAI/CDAI)) may be used as target of therapeutic strategies in rheumatoid arthritis (RA) management. Although ultrasound (US) is a useful imaging technique in RA management, there are no validated US remission criteria. We aimed at analyzing correlations between US and clinical scores in RA patients with clinical remission. Methods: This French multicenter cross-sectional study, in 11 Rheumatology departments, consecutively included patients from August 2015 to April 2016. Inclusions criteria were: RA diagnosis meeting ACREULAR 2010 criteria, <15 years of progression, DAS28-ESR<2.6 for at least 3 months, stable treatment for at least 6 months, including steroids if necessary. Correlations between US scores (Naredo12 B-mode, PD-mode, combined B+PD mode, PDUS scores) and clinical remission composite scores (DAS28-ESR (Erythrocyte Sedimentation Rate), DAS28-CRP (C Reactive Protein), SDAI, CDAI) were analyzed. Results: 225 patients were analyzed. Intra/inter-observer reliabilities were good to excellent. Correlations between clinical and US Naredo12 scores were weak to moderate, with correlation coefficients ranging from 0.086 [-0.05; 0.21] to 0.323 [0.20; 0.44]. Best correlations were observed between PD-mode and SDAI or CDAI. US Naredo12 PD-mode score of 0/36 predicts a SDAI remission with 78% sensitivity and 49% specificity (area under curve 0.65). No association was found between US Naredo12 scores and type of treatment, remission duration or disease duration. Conclusions: There is no strong correlation between US and clinical scores in remission RA patients in routine care. US input in the definition of RA remission remains uncertain.

Serum matrix metalloproteinase 3 levels are associated with an effect of iguratimod as add-on therapy to biological DMARDs in patients with rheumatoid arthritis.

ObjectiveThe aim of this study was to clarify whether serum matrix metalloproteinase 3 (MMP-3) levels are associated with an effect of iguratimod as add-on therapy to biological DMARDs (bDMARDs) in patients with rheumatoid arthritis (RA).MethodsForty three patients with RA were treated with iguratimod as add-on therapy to bDMARDs. They were classified into remission and non-remission groups at 24 weeks of iguratimod therapy. Remission was defined as a state with a disease activity score (DAS) <2.6 in 28 joints (termed DAS remission) and total power Doppler ultrasound (US) score <3 (termed US remission). The serum MMP-3 levels at baseline and at 12 weeks were compared between these two groups.ResultsThere were no significant differences in the serum MMP-3 levels at baseline between the DAS and US remission groups and the non-remission group. The serum MMP-3 levels at 12 weeks in the US remission group were significantly lower than those in the non-remission group. The ratios of the serum MMP-3 levels at baseline to those at 12 weeks in both the DAS and US remission groups were significantly lower than those in the non-remission group. An MMP-3 ratio <0.86 was determined as the cut-off value to predict US remission at 24 weeks.ConclusionOur findings suggest that the ratios of the serum MMP-3 levels at baseline to those at 12 weeks could be used to predict remission in RA patients who are administered iguratimod as an add-on to bDMARDs.

Clinical and ultrasound remission after 6 months of treat-to-target therapy in early rheumatoid arthritis: associations to future good radiographic and physical outcomes

ObjectiveTo explore associations between remission, based on clinical and ultrasound definitions, and future good radiographic and physical outcome in early rheumatoid arthritis (RA).MethodsNewly diagnosed patients with RA followed a treat-to-target...

What is the optimal target for treat-to-target strategies in rheumatoid arthritis?

There has been a trend over time to aim for stricter treatment targets in the treatment of rheumatoid arthritis (RA). We reviewed recent literature to attempt to identify the optimal target in treat-to-target strategies in RA. Achieving lower disease activity was shown to be beneficial, but few studies directly compared the effect of aiming for different treatment targets. Based on the limited available evidence, aiming for remission seems to result in more patients achieving (drug-free) remission than aiming for low disease activity (LDA), but it does not seem to result in better physical functioning. There are indications that adherence to a remission targeted protocol can be lower. In randomized trials in which LDA or remission were compared with ultrasound remission targets, treatment targeted at ultrasound remission was associated with more intensive treatment, but it did not result in better clinical or imaging outcomes. There were no benefits of aiming for ultrasound remission in RA-patients. To decide whether remission or LDA is the best target in the treatment of RA-patients, a randomized clinical trial comparing both targets would be needed. On an individual level, cotargets such as functional ability should be considered.

Add-on iguratimod as a therapeutic strategy to achieve remission in patients with rheumatoid arthritis inadequately responding to biological DMARDs: A retrospective study

Objectives: In this study, iguratimod (IGU) was added to rheumatoid arthritis (RA) patients inadequately responding to 24-week or longer treatment with biological disease-modifying antirheumatic drug (bDMARDs), its effectiveness was assessed, and factors contributing to remission were evaluated.Methods: RA patients who fulfilled the following criteria were included: (i) ≥ 24-week of bDMARDs; (ii) 2.6 < disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR) < 5.1 or the presence of synovitis with a power Doppler (PD) score ≥2 in at least 1 of the 28 joints on joint ultrasonography. Disease activity and joint ultrasound findings were evaluated at baseline and at 12 and 24 weeks.Results: DAS assessing 28 joints with ESR (DAS28-ESR) decreased significantly from 3.45 ± 0.92 at baseline to 2.85 ± 1.13 at 24 weeks (p < .001). Overall, 38.3% achieved clinical remission (c-remission). The total PD score decreased significantly from 8.7 ± 6.1 at baseline to 5.5 ± 5.0 at 24 weeks (p < .001). A lower baseline DAS28-ESR was related to c-remission after 24 weeks (p =.002). Shorter duration of disease (p =.020) was related to ultrasound remission, in addition to a lower baseline DAS28-ESR (p < .001).Conclusions: IGU add-on therapy can be a therapeutic strategy to achieve remission in RA patients inadequately responding to ≥24-week treatment with bDMARDs.

Stratégies d’arrêt ou de réduction des biomédicaments dans la polyarthrite rhumatoïde en rémission

The arrival of new drugs and new therapeutic strategies allowed to reach sustained remission in an increasing number of patients with rheumatoid arthritis. The study of biologic disease-modifying anti-rheumatic drugs (bDMARDs) adaptation strategies is a need to optimize the benefit/risk balance and cost/effectiveness ratio of these molecules. Current recommendations such as EULAR 2016 propose tapering bDMARDs, especially when combined with a csDMARD, when the patient is in remission after stopping persistent glucocorticoids. The analysis of literature comprising 22 studies shows that a bDMARD adaptation is possible in established rheumatoid arthritis when clinico-biological and ultrasound remission is maintained over six months. Priority should be given to a progressive tapering strategy doses controlled by disease activity while maintaining “tight control” to identify and effectively treat a relapse, a retreatment being usually favorable.

Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission?

ObjectiveTo define the synovial characteristics of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in clinical and ultrasound remission achieved by combination therapy with methotrexate (MTX) and tumour necrosis...

Musculoskeletal Ultrasound in the Treat-to-Target Treatment Strategies in Rheumatoid Arthritis

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.

Serum Calprotectin Discriminates Subclinical Disease Activity from Ultrasound-Defined Remission in Patients with Rheumatoid Arthritis in Clinical Remission.

ObjectiveClinical remission in some patients with rheumatoid arthritis (RA) may be associated with ongoing synovial inflammation that is not always detectable on clinical examination or reflected by laboratory tests but can be visualized by musculoskeletal ultrasound. The goal of our study was to determine the levels of serum calprotectin, a major leukocyte protein, in patients with RA in clinical remission and to investigate the ability of serum calprotectin levels to distinguish patients in ultrasound-defined remission from those with residual ultrasound subclinical inflammation.MethodsSeventy RA patients in clinical remission underwent clinical and ultrasound examination. Ultrasound examination was performed according to the German US7 score. Ultrasound remission was defined as grey scale (GS) range 0–1 and power Doppler (PD) range 0. The levels of serum calprotectin and C-reactive protein (CRP) were determined. The discriminatory capacity of calprotectin and CRP in detecting residual ultrasound inflammation was assessed using ROC curves.ResultsThe total number of patients fulfilling the DAS28-ESR, DAS28-CRP, SDAI and CDAI remission criteria was 58, 67, 32 and 31, respectively. Residual synovial inflammation was found in 58–67% of the patients who fulfilled at least one set of clinical remission criteria. Calprotectin levels were significantly higher in patients with residual synovial inflammation than in those with ultrasound-defined remission (mean 2.5±1.3 vs. 1.7±0.8 μg/mL, p<0.005). Using ultrasound-defined remission criteria, calprotectin had an AUC of 0.692, p<0.05 using DAS28-ESR remission criteria and an AUC of 0.712, p<0.005 using DAS28-CRP remission criteria. Calprotectin correctly distinguished ultrasound remission from subclinical activity in 70% of patients. CRP (AUC DAS28-ESR = 0.494, p = NS; AUC DAS28-CRP = 0.498, p = NS) had lower and insignificant discriminatory capacity.ConclusionThe present study demonstrates the potential of calprotectin to distinguish RA patients in both clinical and ultrasound-defined remission from patients in clinical remission but with residual subclinical disease activity.

Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial

ObjectiveTo investigate whether an intensive early rheumatoid arthritis (RA) treat-to-target (T2T) strategy could be improved through the use of musculoskeletal ultrasound (MSUS) assessment of disease activity.Methods111 newly diagnosed patients with...

SAT0385 Lack of Correlation between Clinical and Ultrasonographic Evidence of Disease Activity in Psoriatic Arthritis

BackgroundMusculoskeletal ultrasound (US) has been shown to be a sensitive tool to detect inflammation in inflammatory arthritides [1]. In practice, the composite clinical metric DAS28 is used as a feasible...