Should the Ultrasound of Hands be a Component of Rheumatoid Arthritis Remission Criteria?

Author(s): Akasbi Nessrine*, Driouach Siham, Baya Meryem, El Fakir Samira, Harzy Taoufik.

Journal Name: Current Rheumatology Reviews

Volume 15 , Issue 4 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Introduction: The definition of remission in Rheumatoid Arthritis (RA) is still difficult to determine. An ultrasound of the hands may be important in helping confirm clinical remission.

Objective: This study’s aim was to evaluate the interest in using an ultrasound of the hands to confirm clinical remission, as well as comparing the various remission scores (DAS 28 VS, DAS 28 CRP, and SDAI) and the ultrasound data, in order to deduce the most accurate score to confirm this remission.

Methods: In this prospective monocentric study, we studied patients with rheumatoid arthritis in clinical remission, according to DAS 28 VS, for at least 3 months without corticosteroid therapy. An ultrasound mode B / Doppler of the hands was taken by an experienced rheumatologist, involving 22 joints: wrists, Metacarpophalangeal (MCP) joints and proximal interphalangeal joints (PPI) bilaterally.

Results: Fifty-one patients were included. They were classified in remission according to DAS 28 VS as well as DAS 28 CRP, whereas the remission according to SDAI was achieved in 66.7% of our patients. Synovial hypertrophy and power Doppler were present in respectively 65% and 25% of the patients. SDAI was the most accurate score to confirm RA remission (p < 0.003).

Conclusion: SDAI appears to be the most appropriate score for the definition of remission in rheumatoid arthritis, but despite the use of the latter, ultrasound synovitis may still be present. Further work deserves to be done to clarify the value of ultrasound evaluation in the definition of RA remission.

Keywords: Rheumatoid arthritis, remission, composite scores, hand ultrasound, rheumatic disease, clinical synovitis.

[1]
Pincus T, Kavanaugh A, Aletaha D, Smolen J. Complexities in defining remission in rheumatic diseases. Clin Exp Rheumatol 2006; 24(6)(Suppl. 43): S-1-6.
[PMID: 17083755]
[2]
Prevoo ML, van ’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. 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(1): 44-8.
[http://dx.doi.org/10.1002/art.1780380107] [PMID: 7818570]
[3]
Smolen JS, Breedveld FC, Schiff MH, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford) 2003; 42(2): 244-57.
[http://dx.doi.org/10.1093/rheumatology/keg072] [PMID: 12595618]
[4]
Mouterde G, Morel J. Role of ultrasound for evaluating rheumatoid arthritis in re-mission Revue du Rhumatisme Monographies 2015; 82(4): 225-32.
[5]
Wakefield RJ, Balint PV, Szkudlarek M, et al. OMERACT 7 Special Interest Group. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32(12): 2485-7.
[PMID: 16331793]
[6]
Khanna D, Oh M, Furst DE, et al. Western Consortium of Practicing Rheumatologists. Evaluation of the preliminary definitions of minimal disease activity and remission in an early seropositive rheumatoid arthritis cohort. Arthritis Rheum 2007; 57(3): 440-7.
[http://dx.doi.org/10.1002/art.22619] [PMID: 17394230]
[7]
Smolen JS, Aletaha D. Activity assessments in rheumatoid arthritis. Curr Opin Rheumatol 2008; 20(3): 306-13.
[http://dx.doi.org/10.1097/BOR.0b013e3282fbd382] [PMID: 18388523]
[8]
Balsa A1, de Miguel E, Castillo C, Peiteado D, Martín-Mola E. Superiority of SDAI over DAS-28 in assessment ofremission in rheumatoid arthritis patients usingpower Doppler ultrasonography as a gold standard. Rheumatology (Oxford) 2010; 49(4): 683-90.
[http://dx.doi.org/10.1093/rheumatology/kep442] [PMID: 20047979]
[9]
Ben Abdelghani K, Miladi S, Souabni L, et al. Zakraoui Role of ultrasound in assessing remission in rheu-matoid arthritis. Diagnostic and Interventional Imaging 2015; 96(1): 3-10.
[http://dx.doi.org/10.1016/j.diii.2014.07.006] [PMID: 25220573]
[10]
Ahmed Bezza Interest of ultrasonography in rheumtoid arthritis. Rev Mar Rhum 2013; 23: 12-5.
[11]
Karim Z, Wakefield RJ, Quinn M, et al. Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis Rheum 2004; 50(2): 387-94.
[http://dx.doi.org/10.1002/art.20054] [PMID: 14872480]
[12]
Wakefield RJ, Brown AK, O’Connor PJ, Emery P. Power Doppler sonography: improving disease activity assessment in inflammatory musculoskeletal disease. Arthritis Rheum 2003; 48(2): 285-8.
[http://dx.doi.org/10.1002/art.10818] [PMID: 12571834]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 4
Year: 2019
Page: [312 - 315]
Pages: 4
DOI: 10.2174/1573397115666181231115233
Price: $58

Article Metrics

PDF: 19
HTML: 3
EPUB: 1
PRC: 2

Special-new-year-discount