Positive synovial vascularity in patients with low disease activity indicates smouldering inflammation leading to joint damage in rheumatoid arthritis: time-integrated joint inflammation estimated by synovial vascularity in each finger joint.

OBJECTIVE To investigate the relationship between synovial vascularity and joint damage progression in each finger joint of patients with RA under low disease activity during treatment with biologic agents. METHODS We studied 310 MCP and 310 PIP joints of 31 patients with active RA who were administered adalimumab (ADA) or tocilizumab (TCZ). Patients were examined with clinical and laboratory assessments. Power Doppler sonography was performed at baseline and at weeks 8, 20 and 40. Synovial vascularity was evaluated according to quantitative measurement. Hand and foot radiography was performed at baseline and at week 50. RESULTS Composite scores of the DAS with 28 joints and the Simplified Disease Activity Index (SDAI) were significantly decreased from baseline to week 8, being sustained at a low level by biologic agents during the observational period. MCP and PIP joints with positive synovial vascularity after week 8 showed more subsequent joint damage progression than joints without synovial vascularity throughout the follow-up. The changes in radiographic progression in these joints were independent of the sum of synovial vascularity from baseline to week 40 or the occasional occurrence of positive synovial vascularity. CONCLUSION Smouldering inflammation reflected by positive synovial vascularity under low disease activity was linked to joint damage. The damage progressed irrespective of the severity of positive synovial vascularity. Even with a favourable overall therapeutic response, monitoring of synovial vascularity has the potential to provide useful joint information to tailor treatment strategies. Trial registration. University Hospital Medical Information Network Clinical Trials Registry; http://www.umin.ac.jp/ctr/; UMIN000004476.

[1]  Tamotsu Kamishima,et al.  Radiographic prognosis of finger joint damage predicted by early alteration in synovial vascularity in patients with rheumatoid arthritis: Potential utility of power doppler sonography in clinical practice , 2011, Arthritis care & research.

[2]  W. Schmidt,et al.  Ultrasonography in inflammatory rheumatic disease: an overview , 2011, Nature Reviews Rheumatology.

[3]  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.

[4]  G. Ferraccioli,et al.  Clinical and ultrasonographic remission determines different chances of relapse in early and long standing rheumatoid arthritis , 2010, Annals of the rheumatic diseases.

[5]  M. Dougados,et al.  Reproducibility of Joint Swelling Assessment by Sonography in Patients with Long-lasting Rheumatoid Arthritis (SEA-Repro Study Part II) , 2010, The Journal of Rheumatology.

[6]  Tamotsu Kamishima,et al.  Change of synovial vascularity in a single finger joint assessed by power doppler sonography correlated with radiographic change in rheumatoid arthritis: Comparative study of a novel quantitative score with a semiquantitative score , 2010, Arthritis care & research.

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

[8]  E. Naredo,et al.  Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. , 2008, Arthritis and rheumatism.

[9]  E. Brahn,et al.  Angiogenesis inhibition as a therapeutic approach for inflammatory synovitis , 2007, Nature Clinical Practice Rheumatology.

[10]  Esperanza Naredo,et al.  Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. , 2007, Arthritis and rheumatism.

[11]  S. van der Linden,et al.  Deciding on progression of joint damage in paired films of individual patients: smallest detectable difference or change , 2004, Annals of the rheumatic diseases.

[12]  H K Genant,et al.  Assessment of rheumatoid arthritis using a modified scoring method on digitized and original radiographs. , 1998, Arthritis and rheumatism.

[13]  A. Koch,et al.  Angiogenesis: Implications for rheumatoid arthritis , 1998 .

[14]  J J Anderson,et al.  American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis. , 1995, Arthritis and rheumatism.

[15]  J. Rubin,et al.  Detection of soft-tissue hyperemia: value of power Doppler sonography. , 1994, AJR. American journal of roentgenology.

[16]  M. Dougados,et al.  The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound , 2012, Annals of the rheumatic diseases.

[17]  S. Berney.  Presence of Significant Synovitis in Rheumatoid Arthritis Patients With Disease-Modifying Antirheumatic Drug–Induced Clinical Remission: Evidence From an Imaging Study May Explain Structural Progression , 2008 .

[18]  A. Iagnocco,et al.  Ultrasound imaging for the rheumatologist VII. Ultrasound imaging in rheumatoid arthritis. , 2007, Clinical and experimental rheumatology.

[19]  I Cavazzana,et al.  Mechanisms of immune-mediated skin diseases: an overview. , 2006, Clinical and experimental rheumatology.

[20]  A. Koch.  Review: angiogenesis: implications for rheumatoid arthritis. , 1998, Arthritis and rheumatism.

[21]  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.