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Vol. 15. Issue 4.
Pages 218-222 (July - August 2019)
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Vol. 15. Issue 4.
Pages 218-222 (July - August 2019)
Original Article
DOI: 10.1016/j.reumae.2017.08.008
Subclinical synovitis measured by ultrasound in rheumatoid arthritis patients with clinical remission induced by synthetic and biological modifying disease drugs
Sinovitis subclínica medida por ultrasonido en pacientes con artritis reumatoide en remisión clínica inducida por fármacos modificadores de la enfermedad sintéticos y biológicos
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Marcos Crucesa,b,
Corresponding author
marcoscruces48@hotmail.com

Corresponding author.
, Soham Al Snihc, Natalí Serra-Bonetta,b, Juan C. Rivasa,b
a Division of Rheumatology, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
b Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
c Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
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Tables (3)
Table 1. Demographic, Clinical, and Biological Characteristics of the Sample by Treatment Groups (DMARD and DMARD Plus Biological Therapy) (N=58).
Table 2. Synovitis Detected by US in Patients With Disease-modifying Antirheumatic Drugs (DMARD) and DMARD Plus Biological Therapy (N=58).
Table 3. Correlation Between Clinical and Biological Variables With US Findings.
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Abstract
Background

Rheumatoid arthritis (RA) patients with disease in clinical remission might show subclinical synovitis, which can be related to the progress of structural joint damage.

Objective

To determine and compare the degree of synovial inflammation by ultrasound (US) in patients with RA in clinical remission, treated with DMARD or combination therapy with DMARD and anti-TNF.

Methods

Hospital-based cross-sectional study of 58 patients with RA in sustained remission for at least 6 months by DAS28 <2.6, who attended the Rheumatology Service at the Hospital Universitario de Caracas. Patients underwent clinical, functional, and laboratory assessments. Ultrasound was performed in hands measuring synovial effusion, synovial hypertrophy and power Doppler signal; using a semiquantitative 4-point scale of 0=none to 3=severe. Chi-square and t-test were used to compare the clinical, functional, laboratory and US assessments between the DMARD (N=37) and combination therapy with DMARD and anti-TNF (N=21) groups. A p-value <0.05 was considered statistically significant.

Results

Out of 58 patients, 25.9% had remission by US and 74.1% had synovial effusion or hypertrophy or positive power Doppler signal. Non-significant differences in US synovitis between the two groups were found.

Conclusions

Persistent US activity was evident in a high percentage of rheumatoid arthritis patients in clinical remission by DAS28. No differences in subclinical synovitis measured by US were found between patients with DMARD and anti-TNF-induced clinical remission.

Keywords:
Rheumatoid arthritis
Clinical remission
Subclinical synovitis
Musculoskeletal ultrasound
Resumen
Introducción

Los pacientes con artritis reumatoide (AR) con enfermedad en remisión clínica pueden mostrar sinovitis subclínica, que puede estar relacionada con el progreso del daño articular estructural.

Objetivos

Determinar y comparar el grado de inflamación sinovial medida por ultrasonido (US) en pacientes con AR en remisión clínica, tratados con FAME o FAME y anti-TNF.

Métodos

Estudio transversal con sede en hospital, donde se evaluaron 58 pacientes con AR en remisión sostenida durante al menos 6 meses por DAS28<2,6, que asistieron al Servicio de Reumatología del Hospital Universitario de Caracas. Se realizó evaluación clínica, funcional y de laboratorio. Se practicó US en manos evaluando derrame, hipertrofia sinovial y presencia de señal power Doppler, utilizando una escala semicuantitativa de 4 puntos 0=ninguno a 3=severo. Se compararon los hallazgos entre los pacientes con FAME (n=37) y FAME y anti-TNF (n=21), utilizando las pruebas de Chi-cuadrado y t de Student. Se consideró significación estadística si el valor de p era<0,05.

Resultados

De los 58 pacientes, el 25,9% tuvo remisión por US y el 74,1% presentó derrame, hipertrofia sinovial o señal power Doppler positiva. No hubo diferencias significativas en la presencia de sinovitis medida por US entre los 2 grupos.

Conclusiones

En pacientes en remisión clínica por DAS28, la actividad persistente medida por US fue evidente en un alto porcentaje. No hubo diferencias en la sinovitis subclínica medida por US entre los pacientes en remisión clínica inducida con FAME y FAME y anti-TNF.

Palabras clave:
Artritis reumatoide
Remisión clínica
Sinovitis subclínica
Ultrasonido musculoesquelético

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