Investigation of remission with ultrasound in patients with rheumatoid arthritis according to different clinical remission criteria

Yıl 2022, Cilt: 8 Sayı: 5, 722 - 731, 04.09.2022

Selime Ermurat Belkıs Nihan Coşkun Burcu Yağız Hüseyin Ediz Dalkılıç Yavuz Pehlivan

https://doi.org/10.18621/eurj.1091860

Öz

Objectives: To investigate remission with ultrasound (US) in patients with Rheumatoid arthritis (RA) according to different clinical remission criteria.

Methods: A total of 105 patients with RA who were in remission for at least 6 months according to disease activity score in the 28 joints using C-reactive protein (DAS28-CRP) were included in the study. US remission rates were analyzed according to different remission criteria [DAS28-CRP, DAS28 using erythrocyte sedimentation rate (DAS28-ESR), clinical disease activity index (CDAI), simplified DAI (SDAI), and the 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean remission criteria]. US remission was determined as power doppler (PD) US score = 0.

Results: Remission rates achieved for each remission criteria were 100%, 82.9%, 55.2%, 58.1% and 42.9% and US remission rates were 57.1%, 57.5%, 53.4%, 55.7%, 57.7% for DAS28 CRP, DAS 28 ESR, CDAI, SDAI, 2011 ACR/EULAR remission criteria, respectively. When the patients compared for the US findings between remission and non-remission patients according to the different clinical remission criteria, no difference was found (p > 0.05).

Conclusions: This study shows that clinical remission criterias are not sensitive enough to accurately detect remission and there was no increase in the US remission rates as per the stricter remission criteria. Using US in addition to the clinical criteria would prove to be more useful in evaluating remission.

Anahtar Kelimeler

Clinical remission, ultrasonographic remission, rheumatoid arthritis, subclinical synovitis, DAS28 CRP, remission criteria

Kaynakça

• 1. Heidari B. Rheumatoid Arthritis: early diagnosis and treatment outcomes. Caspian J Intern Med 2011;2:161-70.
• 2. Schipper LG, Vermeer M, Kuper HH, Hoekstra MO, Haagsma CJ, Den Broeder AA, et al. A tight control treatment strategy aiming for remission in early rheumatoid arthritis is more effective than usual care treatment in daily clinical practice: a study of two cohorts in the Dutch Rheumatoid Arthritis Monitoring registry. Ann Rheum Dis 2012;71:845-50.
• 3. Prevoo M, Van'T Hof MA, Kuper H, Van Leeuwen M, Van De Putte L, Van Riel P. Modified disease activity scores that include twenty‐eight‐joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38:44-8.
• 4. Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, et al. American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis 2011;70:404-13.
• 5. Aletaha D, Ward MM, Machold KP, Nell VP, Stamm T, Smolen JS. Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum 2005;52:2625-36.
• 6. Terslev L, Brahe CH, Østergaard M, Fana V, Ammitzbøll-Danielsen M, Møller T, et al. Using a DAS28-CRP-steered treat-to-target strategy does not eliminate subclinical inflammation as assessed by ultrasonography in rheumatoid arthritis patients in longstanding clinical remission. Arthritis Res Ther 2021;23:48.
• 7. Smolen JS, Han C, van der Heijde DM, Emery P, Bathon JM, Keystone E, et al. Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade. Ann Rheum Dis 2009;68:823-7.
• 8. Landewé R, van der Heijde D, Klareskog L, van Vollenhoven R, Fatenejad S. Disconnect between inflammation and joint destruction after treatment with etanercept plus methotrexate: results from the trial of etanercept and methotrexate with radiographic and patient outcomes. Arthritis Rheum 2006;54:3119-25.
• 9. Smolen JS, Han C, Bala M, Maini RN, Kalden JR, van der Heijde D, et al. ATTRACT Study Group. Evidence of radiographic benefit of treatment with infliximab plus methotrexate in rheumatoid arthritis patients who had no clinical improvement: a detailed subanalysis of data from the anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study. Arthritis Rheum 2005;52:1020-30.
• 10. Haavardsholm EA, Aga AB, Olsen IC, Lillegraven S, Hammer HB, Uhlig T, et al. Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial. BMJ 2016;354:i4205.
• 11. Dale J, Stirling A, Zhang R, Purves D, Foley J, Sambrook M, et al. Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial. Ann Rheum Dis 2016;75:1043-50.
• 12. do Prado AD, Staub HL, Bisi MC, da Silveira IG, Mendonça JA, Polido-Pereira J,et al. Ultrasound and its clinical use in rheumatoid arthritis: where do we stand? Adv Rheumatol 2018;58:19.
• 13. Ben Abdelghani K, Miladi S, Souabni L, Kassab S, Chekili S, Laatar A, et al. Role of ultrasound in assessing remission in rheumatoid arthritis. Diagn Interv Imaging 2015;96:3-10.
• 14. Alivernini S, Tolusso B, Petricca L, Bui L, Di Sante G, Peluso G, et al. 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? Ann Rheum Dis 2017;76:1228-36.
• 15. Saleem B, Brown AK, Keen H, Nizam S, Freeston J, Karim Z, et al. Disease remission state in patients treated with the combination of tumor necrosis factor blockade and methotrexate or with disease-modifying antirheumatic drugs: a clinical and imaging comparative study. Arthritis Rheum 2009;60:1915-22.
• 16. Geng Y, Han J, Deng X, Zhang Z. Presence of power Doppler synovitis in rheumatoid arthritis patients with synthetic and/or biological disease-modifying anti-rheumatic drug-induced clinical remission: experience from a Chinese cohort. Clin Rheumatol 2014;33:1061-6.
• 17. Rizzo C, Ceccarelli F, Gattamelata A, Vavala C, Valesini G, Iagnocco A. Ultrasound in rheumatoid arthritis. Med Ultrason 2013;15:199-208.
• 18. Iagnocco A, Epis O, Delle Sedie A, Meenagh G, Filippucci E, Riente L, et al. Ultrasound imaging for the rheumatologist. XVII. Role of colour Doppler and power Doppler. Clin Exp Rheumatol 2008;26:759-62.
• 19. Raffeiner B, Grisan E, Botsios C, Stramare R, Rizzo G, Bernardi L, et al. Grade and location of power Doppler are predictive of damage progression in rheumatoid arthritis patients in clinical remission by anti-tumour necrosis factor α. Rheumatology (Oxford) 2017;56:1320-5.
• 20. Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A. Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. Rheumatology (Oxford) 2014;53:2110-8.
• 21. Han J, Geng Y, Deng X, Zhang Z. Subclinical synovitis assessed by ultrasound predicts flare and progressive bone erosion in rheumatoid arthritis patients with clinical remission: a systematic review and metaanalysis. J Rheumatol 2016;43:2010-8.
• 22. Lillegraven S, Prince FH, Shadick NA, Bykerk VP, Lu B, Frits ML, et al. Remission and radiographic outcome in rheumatoid arthritis: application of the 2011 ACR/EULAR remission criteria in an observational cohort. Ann Rheum Dis 2012;71:681-6.
• 23. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005;32:2485-7.
• 24. Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 2009;61:1194-201.
• 25. Bykerk VP, Massarotti EM. The new ACR/EULAR remission criteria: rationale for developing new criteria for remission. Rheumatology (Oxford, England) 2012;51 Suppl 6:vi16-20.
• 26. Ten Cate DF, Luime JJ, Swen N, Gerards AH, De Jager MH, Basoski NM, et al. Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis--a systematic review of the literature. Arthritis Res Ther 2013;15:R4.
• 27. Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008;58:2958-67.
• 28. Van der Ven M, Kuijper TM, Gerards AH, Tchetverikov I, Weel AE, van Zeben J, et al. No clear association between ultrasound remission and health status in rheumatoid arthritis patients in clinical remission. Rheumatology (Oxford) 2017;56:1276-81.
• 29. Balsa A, de Miguel E, Castillo C, Peiteado D, Martín-Mola E. Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology (Oxford, England). 2010;49:683-90.
• 30. Naredo E, Valor L, De la Torre I, Martínez-Barrio J, Hinojosa M, Aramburu F, et al. Ultrasound joint inflammation in rheumatoid arthritis in clinical remission: how many and which joints should be assessed? Arthritis Care Res (Hoboken) 2013;65:512-7.
• 31. Peluso G, Michelutti A, Bosello S, Gremese E, Tolusso B, Ferraccioli G. Clinical and ultrasonographic remission determines different chances of relapse in early and long standing rheumatoid arthritis. Ann Rheumatic Dis 2011;70:172-5.
• 32. Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020;79:685-99.