Document Detail

An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis.
MedLine Citation:
PMID:  18821687     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Achieving remission is the aim of treatment in rheumatoid arthritis (RA). This should represent minimal arthritis activity and ensure optimal disease outcome. However, we have previously demonstrated a high prevalence of imaging-detected synovial inflammation in RA patients who were in clinical remission. The purpose of this study was to evaluate the long-term significance of subclinical synovitis and its relationship to structural outcome.
METHODS: We studied 102 RA patients receiving conventional treatment who had been judged by their consultant rheumatologist to be in remission, as well as 17 normal control subjects. Subjects underwent clinical, laboratory, functional, and quality of life assessments over 12 months. In addition to standard radiography of the hands and feet, imaging of the hands and wrists was performed with musculoskeletal ultrasonography (US) and conventional 1.5 T magnetic resonance imaging (MRI) at baseline and 12 months, using validated acquisition and scoring techniques.
RESULTS: Despite their being in clinical remission, 19% of the patients displayed deterioration in radiographic joint damage over the study period. Scores on musculoskeletal US synovial hypertrophy, power Doppler (PD), and MRI synovitis assessments in individual joints at baseline were significantly associated with progressive radiographic damage (P=0.032, P<0.001, and P=0.002, respectively). Furthermore, there was a significant association between the musculoskeletal US PD score at baseline and structural progression over 12 months in totally asymptomatic metacarpophalangeal joints (P=0.004) and 12 times higher odds of deterioration in joints with increased PD signal (odds ratio 12.21, P<0.001).
CONCLUSION: Subclinical joint inflammation detected by imaging techniques explains the structural deterioration in RA patients in clinical remission who are receiving conventional therapy. Our findings reinforce the utility of imaging for the accurate evaluation of disease status and the prediction of structural outcome.
A K Brown; P G Conaghan; Z Karim; M A Quinn; K Ikeda; C G Peterfy; E Hensor; R J Wakefield; P J O'Connor; P Emery
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  58     ISSN:  0004-3591     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-09     Completed Date:  2008-12-04     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2958-67     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Anti-Inflammatory Agents / therapeutic use*
Antirheumatic Agents / therapeutic use*
Arthritis, Rheumatoid / drug therapy*,  pathology*,  physiopathology
Case-Control Studies
Disease Progression
Longitudinal Studies
Middle Aged
Prospective Studies
Remission Induction
Synovitis / immunology,  pathology
Wrist Joint / pathology*,  physiopathology
Grant Support
18475//Arthritis Research UK; //Arthritis Research UK
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Antirheumatic Agents
Comment In:
Arthritis Rheum. 2008 Oct;58(10):2925-7   [PMID:  18821696 ]

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