Objectives:

The objective of this study was to assess the prevalence of ultrasound (US) abnormalities and association with clinical parameters in rheumatoid arthritis (RA) clinical remission.

Methods:

Patients with established RA in clinical remission (DAS28-CRP < 2.4) taking conventional synthetic disease-modifying anti-rheumatic drugs were recruited as part of the Biomarkers of Remission in Rheumatoid Arthritis (BioRRA) Study. In addition, patients from the Newcastle Early Arthritis Clinic (NEAC) with early active RA (DAS28-CRP > 2.4) or seronegative non-inflammatory arthralgia (NIA) were studied as positive and negative controls, respectively. The association between individual dependent variables (synovial power Doppler and greyscale, tenosynovial greyscale, and erosions) and clinical parameters was assessed by multivariate ordinal logistic regression, with adjustment for multiple testing.

Results:

A total of 294 patients were included: 66 RA in remission, 146 active RA, and 82 NIA. Within the active RA group, significant associations were observed between swollen joint count and higher total synovial greyscale score (OR 1.17 95% CI 1.08–1.26, p < 0.001) and higher total synovial power Doppler score (OR 1.20, 95% CI 1.12–1.30, p < 0.001). No significant associations were observed for the NIA group. In the RA remission group, US abnormalities were frequently observed and comparable for both DAS28-CRP and 2011 ACR/EULAR Boolean remission, with no significant association with clinical parameters identified.

Conclusion:

We observed widespread subclinical US findings in RA patients in clinical remission, even when remission is defined using the stringent ACR/EULAR Boolean criteria. In contrast to active disease, synovial power Doppler failed to show significant association with any of the clinical parameters in RA remission. Our results suggest that clinical and US examinations are non-overlapping in evaluating RA remission, challenging the proposition of US-driven management strategies in this setting.

中文翻译：

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类风湿性关节炎缓解中疾病活动性的临床和超声测量之间缺乏关联。

 目标：

本研究的目的是评估超声 (US) 异常的发生率及其与类风湿关节炎 (RA) 临床缓解中临床参数的关联。

 方法：

作为类风湿关节炎缓解生物标志物 (BioRRA) 研究的一部分，招募了服用传统合成缓解病情抗风湿药物的临床缓解期 RA 患者 (DAS28-CRP < 2.4)。此外，来自纽卡斯尔早期关节炎诊所 (NEAC) 的早期活动性 RA (DAS28-CRP > 2.4) 或血清阴性非炎症性关节痛 (NIA) 患者分别作为阳性和阴性对照进行研究。通过多元序数逻辑回归评估个体因变量（滑膜功率多普勒和灰度、腱滑膜灰度和糜烂）与临床参数之间的关联，并调整多重测试。

 结果：

总共纳入 294 名患者：66 名缓解期 RA，146 名活动期 RA，82 名 NIA。在活动性 RA 组中，观察到肿胀关节计数与较高的总滑膜灰阶评分（OR 1.17 95% CI 1.08–1.26， p < 0.001）和较高的总滑膜功率多普勒评分（OR 1.20，95% CI 1.12–）之间存在显着相关性。 1.30， p < 0.001）。 NIA 组没有观察到显着的关联。在 RA 缓解组中，经常观察到 US 异常，并且 DAS28-CRP 和 2011 ACR/EULAR 布尔缓解具有可比性，与已确定的临床参数没有显着相关性。

 结论：

我们在临床缓解的 RA 患者中观察到广泛的亚临床超声结果，即使缓解是使用严格的 ACR/EULAR 布尔标准定义的。与活动性疾病相比，滑膜能量多普勒未能显示出与 RA 缓解中的任何临床参数显着相关。我们的结果表明，临床检查和超声检查在评估 RA 缓解方面并不重叠，这对这种情况下超声驱动的管理策略的主张提出了挑战。