Document Detail

Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments.
MedLine Citation:
PMID:  21242236     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Patients can fulfil clinical criteria for remission, yet still have evidence of synovitis detectable clinically and by ultrasound, and this is associated with structural damage. Stricter remission criteria may more accurately reflect true remission (no synovitis). This hypothesis was examined by studying patients using more stringent thresholds for clinical remission and determining their levels of ultrasound synovitis.
METHODS: Rheumatoid arthritis patients with a disease activity score in 28 joints (DAS28) ≤2.6 for at least 6 months were classified using standard and more stringent DAS28 and simplified disease activity index (SDAI) remission thresholds and the corresponding clinical and ultrasound imaging measures of synovitis recorded.
RESULTS: 128 patients (all DAS28 <2.6, median DAS28 1.70) receiving either disease-modifying antirheumatic drugs alone (n=66) or with a tumour necrosis factor blocker (n=62) were recruited. Of the 640 imaged joints, 5% had moderate or severe power Doppler (PD) activity, 8% were clinically swollen and 1% tender. In patients fulfilling DAS28, American College of Rheumatology or SDAI remission criteria, moderate or severe PD activity was present in 21%, 15% and 19%, respectively. More stringent DAS28 and SDAI criteria reduced the mean number of swollen and tender joints (p<0.001) but not the percentage of patients with PD activity: 32 patients had a DAS28 <1.17 but eight (25%) had significant PD activity.
CONCLUSION: Using more stringent remission criteria resulted in reduced signs and symptoms of inflammation, but the percentage of joints with PD activity was not reduced, even in those without signs or symptoms. These data suggest that clinical criteria are sufficiently insensitive to detect low but clinically relevant levels of inflammation accurately.
Benazir Saleem; Andrew K Brown; Helen Keen; Sharmin Nizam; Jane Freeston; Richard Wakefield; Zunaid Karim; Mark Quinn; Elizabeth Hensor; Philip G Conaghan; Paul Emery
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-01-17
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  70     ISSN:  1468-2060     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-04     Completed Date:  2011-06-23     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  792-8     Citation Subset:  IM    
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MeSH Terms
Antirheumatic Agents / therapeutic use
Arthritis, Rheumatoid / complications,  drug therapy,  pathology,  ultrasonography*
Cohort Studies
Middle Aged
Quality of Life
Remission Induction
Severity of Illness Index
Synovitis / etiology,  pathology,  ultrasonography
Treatment Outcome
Grant Support
18475//Arthritis Research UK
Reg. No./Substance:
0/Antirheumatic Agents

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