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The predictive role of ultrasound-detected tenosynovitis and joint synovitis for flare in patients with rheumatoid arthritis in stable remission. Results of an Italian multicentre study of the Italian Society for Rheumatology Group for Ultrasound : The STARTER study

Filippou, Georgios; Sakellariou, Garifallia; Scirè, Carlo Alberto; Carrara, Greta; Rumi, Federica; Bellis, Emanuela; Adinolfi, Antonella; Batticciotto, Alberto; Bortoluzzi, Alessandra and Cagnotto, Giovanni, et al. (2018) In Annals of the Rheumatic Diseases
Abstract

Objective: To define the role of ultrasound (US) for the assessment of patients with rheumatoid arthritis (RA) in clinical remission, including joint and tendon evaluation. Methods: A multicentre longitudinal study has been promoted by the US Study Group of the Italian Society for Rheumatology. 25 Italian centres participated, enrolling consecutive patients with RA in clinical remission. All patients underwent complete clinical assessment (demographic data, disease characteristics, laboratory exams, clinical assessment of 28 joints and patient/physician-reported outcomes) and Power Doppler (PD) US evaluation of wrist, metacarpalphalangeal joints, proximal interphalangeal joints and synovial tendons of the hands and wrists at enrolment,... (More)

Objective: To define the role of ultrasound (US) for the assessment of patients with rheumatoid arthritis (RA) in clinical remission, including joint and tendon evaluation. Methods: A multicentre longitudinal study has been promoted by the US Study Group of the Italian Society for Rheumatology. 25 Italian centres participated, enrolling consecutive patients with RA in clinical remission. All patients underwent complete clinical assessment (demographic data, disease characteristics, laboratory exams, clinical assessment of 28 joints and patient/physician-reported outcomes) and Power Doppler (PD) US evaluation of wrist, metacarpalphalangeal joints, proximal interphalangeal joints and synovial tendons of the hands and wrists at enrolment, 6 and 12 months. The association between clinical and US variables with flare, disability and radiographic progression was evaluated by univariable and adjusted logistic regression models. Results: 361 patients were enrolled, the mean age was 56.20 (±13.31) years and 261 were women, with a mean disease duration of 9.75 (±8.07) years. In the 12 months follow-up, 98/326 (30.1%) patients presented a disease flare. The concurrent presence of PD positive tenosynovitis and joint synovitis predicted disease flare, with an OR (95% CI) of 2.75 (1.45 to 5.20) in crude analyses and 2.09 (1.06 to 4.13) in adjusted analyses. US variables did not predict the worsening of function or radiographic progression. US was able to predict flare at 12 months but not at 6 months. Conclusions: PD positivity in tendons and joints is an independent risk factor of flare in patients with RA in clinical remission. Musculoskeletal ultrasound evaluation is a valuable tool to monitor and help decision making in patients with RA in clinical remission.

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keywords
disease activity, rheumatoid arthritis, treatment, ultrasonography
in
Annals of the Rheumatic Diseases
publisher
British Medical Association
external identifiers
  • scopus:85048375877
ISSN
0003-4967
DOI
10.1136/annrheumdis-2018-213217
language
English
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no
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164d0dc0-9340-4a1f-900c-c0d6a5c80d86
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2018-06-26 13:44:54
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2019-02-20 11:20:47
@article{164d0dc0-9340-4a1f-900c-c0d6a5c80d86,
  abstract     = {<p>Objective: To define the role of ultrasound (US) for the assessment of patients with rheumatoid arthritis (RA) in clinical remission, including joint and tendon evaluation. Methods: A multicentre longitudinal study has been promoted by the US Study Group of the Italian Society for Rheumatology. 25 Italian centres participated, enrolling consecutive patients with RA in clinical remission. All patients underwent complete clinical assessment (demographic data, disease characteristics, laboratory exams, clinical assessment of 28 joints and patient/physician-reported outcomes) and Power Doppler (PD) US evaluation of wrist, metacarpalphalangeal joints, proximal interphalangeal joints and synovial tendons of the hands and wrists at enrolment, 6 and 12 months. The association between clinical and US variables with flare, disability and radiographic progression was evaluated by univariable and adjusted logistic regression models. Results: 361 patients were enrolled, the mean age was 56.20 (±13.31) years and 261 were women, with a mean disease duration of 9.75 (±8.07) years. In the 12 months follow-up, 98/326 (30.1%) patients presented a disease flare. The concurrent presence of PD positive tenosynovitis and joint synovitis predicted disease flare, with an OR (95% CI) of 2.75 (1.45 to 5.20) in crude analyses and 2.09 (1.06 to 4.13) in adjusted analyses. US variables did not predict the worsening of function or radiographic progression. US was able to predict flare at 12 months but not at 6 months. Conclusions: PD positivity in tendons and joints is an independent risk factor of flare in patients with RA in clinical remission. Musculoskeletal ultrasound evaluation is a valuable tool to monitor and help decision making in patients with RA in clinical remission.</p>},
  author       = {Filippou, Georgios and Sakellariou, Garifallia and Scirè, Carlo Alberto and Carrara, Greta and Rumi, Federica and Bellis, Emanuela and Adinolfi, Antonella and Batticciotto, Alberto and Bortoluzzi, Alessandra and Cagnotto, Giovanni and Caprioli, Marta and Canzoni, Marco and Cavatorta, Francesco Paolo and De Lucia, Orazio and Di Sabatino, Valentina and Draghessi, Antonella and Farina, Ilaria and Focherini, Maria Cristina and Gabba, Alessandra and Gutierrez, Marwin and Idolazzi, Luca and Luccioli, Filippo and Macchioni, Pierluigi and Massarotti, Marco Sergio and Mastaglio, Claudio and Menza, Luana and Muratore, Maurizio and Parisi, Simone and Picerno, Valentina and Piga, Matteo and Ramonda, Roberta and Raffeiner, Bernd and Rossi, Daniela and Rossi, Silvia and Rossini, Paola and Scioscia, Crescenzio and Venditti, Carlo and Volpe, Alessandro and Iagnocco, Annamaria},
  issn         = {0003-4967},
  keyword      = {disease activity,rheumatoid arthritis,treatment,ultrasonography},
  language     = {eng},
  month        = {06},
  publisher    = {British Medical Association},
  series       = {Annals of the Rheumatic Diseases},
  title        = {The predictive role of ultrasound-detected tenosynovitis and joint synovitis for flare in patients with rheumatoid arthritis in stable remission. Results of an Italian multicentre study of the Italian Society for Rheumatology Group for Ultrasound : The STARTER study},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2018-213217},
  year         = {2018},
}