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

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.

[1]  T. Huizinga,et al.  The value of MRI examination on bilateral hands including proximal interphalangeal joints for disease assessment in patients with early rheumatoid arthritis: a cross-sectional cohort study , 2019, Arthritis Research & Therapy.

[2]  D. M. van der Heijde,et al.  Should radiographic progression still be used as outcome in RA? , 2017, Clinical immunology.

[3]  M. Boers,et al.  Is it time to revisit the role of ultrasound in rheumatoid arthritis management? , 2016, Annals of the rheumatic diseases.

[4]  A. Iagnocco,et al.  Ultrasound-detected tenosynovitis independently associates with patient-reported flare in patients with rheumatoid arthritis in clinical remission: results from the observational study STARTER of the Italian Society for Rheumatology. , 2016, Rheumatology.

[5]  M. D’Agostino,et al.  Prevalence of ultrasound synovial inflammatory findings in healthy subjects. , 2016, Annals of the rheumatic diseases.

[6]  D. M. van der Heijde,et al.  Is radiographic progression in modern rheumatoid arthritis trials still a robust outcome? Experience from tofacitinib clinical trials , 2016, Arthritis Research & Therapy.

[7]  A. Iagnocco,et al.  Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission , 2016, Annals of the rheumatic diseases.

[8]  Inge Christoffer Olsen,et al.  Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial , 2016, British Medical Journal.

[9]  D. M. van der Heijde,et al.  Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial , 2016, Annals of the rheumatic diseases.

[10]  T. Maribo,et al.  Patient self-assessment of flare in rheumatoid arthritis: criterion and concurrent validity of the Flare instrument , 2016, Clinical Rheumatology.

[11]  A. Iagnocco,et al.  Value of ultrasonography as a marker of early response to abatacept in patients with rheumatoid arthritis and an inadequate response to methotrexate: results from the APPRAISE study , 2015, Annals of the rheumatic diseases.

[12]  A. Constantin,et al.  Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. , 2014, Rheumatology.

[13]  A. Iagnocco,et al.  Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability , 2013, Annals of the rheumatic diseases.

[14]  M. Lunt,et al.  Early remission is associated with improved survival in patients with inflammatory polyarthritis: results from the Norfolk Arthritis Register , 2013, Annals of the rheumatic diseases.

[15]  Désirée van der Heijde,et al.  EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis , 2013, Annals of the rheumatic diseases.

[16]  Jolanda J Luime,et al.  Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis - a systematic review of the literature , 2013, Arthritis Research & Therapy.

[17]  P. V. van Riel,et al.  Construct and criterion validity of several proposed DAS28-based rheumatoid arthritis flare criteria: an OMERACT cohort validation study , 2012, Annals of the rheumatic diseases.

[18]  Walter Grassi,et al.  Hand tendon involvement in rheumatoid arthritis: an ultrasound study. , 2012, Seminars in arthritis and rheumatism.

[19]  D. Felson.  Defining remission in rheumatoid arthritis , 2012, Annals of the rheumatic diseases.

[20]  F. Guillemin,et al.  A tool to identify recent or present rheumatoid arthritis flare from both patient and physician perspectives: The ‘FLARE’ instrument , 2011, Annals of the rheumatic diseases.

[21]  W. Grassi,et al.  [Thumb troubles in rheumatoid arthritis]. , 2011, Reumatismo.

[22]  Mahboob Rahman,et al.  Changes in patient characteristics in anti-tumour necrosis factor clinical trials for rheumatoid arthritis: results of an analysis of the literature over the past 16 years , 2011 .

[23]  David T Felson,et al.  UvA-DARE (Digital Academic Repository) American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials , 2011 .

[24]  P. Emery,et al.  Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments , 2011, Annals of the rheumatic diseases.

[25]  A. Silman,et al.  Rheumatoid arthritis classifi cation criteria : an American College of Rheumatology / European League Against Rheumatism collaborative initiative , 2010 .

[26]  Tsutomu Takeuchi,et al.  EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update , 2010, Annals of the rheumatic diseases.

[27]  John Wong,et al.  EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs , 2010, Annals of the rheumatic diseases.

[28]  R. Caporali,et al.  Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. , 2009, Rheumatology.

[29]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[30]  D. Khanna,et al.  The Minimally Important Difference for the Health Assessment Questionnaire in Rheumatoid Arthritis Clinical Practice Is Smaller Than in Randomized Controlled Trials , 2009, The Journal of Rheumatology.

[31]  C. Peterfy,et al.  An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. , 2008, Arthritis and rheumatism.

[32]  Franz Kainberger,et al.  Musculoskeletal ultrasound including definitions for ultrasonographic pathology. , 2005, The Journal of rheumatology.

[33]  S. van der Linden,et al.  Progression of rheumatoid arthritis on plain radiographs judged differently by expert radiologists and rheumatologists. , 2004, The Journal of rheumatology.

[34]  P. Tugwell,et al.  A simplified disease activity index for rheumatoid arthritis for use in clinical practice. , 2003, Rheumatology.

[35]  W. Grassi,et al.  Guidelines for musculoskeletal ultrasound in rheumatology , 2001, Annals of the rheumatic diseases.

[36]  J J Anderson,et al.  The American college of rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials , 1993 .

[37]  G. Calori,et al.  The Italian version of the Functional Disability Index of the Health Assessment Questionnaire. A reliable instrument for multicenter studies on rheumatoid arthritis. , 1993, Clinical and experimental rheumatology.

[38]  M. Liang,et al.  The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. , 1988, Arthritis and rheumatism.

[39]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[40]  L. R. Straub,et al.  Spontaneous rupture of extensor tendons in the hand associated with rheumatoid arthritis. , 1956, The Journal of bone and joint surgery. American volume.

[41]  Maarten Boers,et al.  Progression of radiologic damage in patients with rheumatoid arthritis in clinical remission. , 2004, Arthritis and rheumatism.

[42]  M. Prevoo,et al.  Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. , 1995, Arthritis and rheumatism.