SAT0530 Deep Clinical Remission - An Optimized Target in The Management of Rheumatoid Arthritis? Experience from An Ultrasonography Study
Authors: Y. Geng, Z. Zhang
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Treat-to-target strategy, aiming at clinical remission, has greatly improved the prognosis of RA. However, the ultrasonographic subclinical synovitis was correlated with bone erosion and disease flare. <h3>Objectives</h3> The aim of this study was to evaluate whether deeper clinical remission (DAS28(ESR) ≤1.98) reflects the better control of subclinical synovitis. <h3>Methods</h3> 126 RA patients in clinical remission were enrolled in the study. Disease activity and ultrasongraphy were evaluated at baseline, and every 3 months during a 12-month follow-up. The relationship between the extent of clinical remission, flare and ultrasonographic features was analyzed. <h3>Results</h3> In 126 RA patients, 76 achieved deep clinical remission and 50 achieved mild clinical remission. In all, 54 (42.9%) patients relapsed at average of 6.8±3.3 months during follow-up. Patients in deep remission possessed not only lower risk to relapse (30.3% vs. 62.0%, <i>P</i>&lt;0.01), but also longer duration of remission before relapse (8.1±3.3 vs. 5.9±3.1 months, <i>P</i>&lt;0.05). Besides, applying DAS28(ESR) &lt;1.895 to predict ultrasonographic remission defined as negativity of both PD and SH was highly accurate (<i>P</i>&lt;0.001). Subclinical PD synovitis at baseline was an independent risk factor for predicting relapse in RA patients achieved clinical remission (OR 8.8 [95% CI 2.7–28.4]). <h3>Conclusions</h3> Subclinical synovitis was common in RA patients even in deep clinical remission. The deeper the clinical remission, the milder the subclinical synovitis, and the lower risk to relapse. Therefore, achieving deeper clinical remission, which reflected better control of subclinical synovitis and less tendency to flare, could be an optimized treatment target of RA. <h3>References</h3> Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014;73: 492–509. Hetland ML, Jensen DV, Krogh NS. Monitoring patients with rheumatoid arthritis in routine care: experiences from a treat-to-target strategy using the DANBIO registry. Clin Exp Rheumatol. 2014;32:S-141–6. Molenaar ET, Voskuyl AE, Dinant HJ, Bezemer PD, Boers M, Dijkmans BA. Progression of radiologic damage in patients with rheumatoid arthritis in clinical remission. Arthritis Rheum 2004;50:36–42. Tanaka Y, Hiratai S, Kubo S, et al. Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study. Ann Rheum Dis 2015;74:389–95. Geng Y, Han J, Deng X, Zhang Z. Presence of power Doppler synovitis in rheumatoid arthritis patients with synthetic and/or biological disease-modifying anti-rheumatic drug-induced clinical remission: experience from a Chinese cohort. Clin Rheumatol 2014;33:1061–6. Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A. 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. Rheumatology (Oxford) 2014;53:2110–8. <h3>Acknowledgement</h3> We thank our colleagues for their assistance in the aspect of data collection and statistics. The authors also gratefully acknowledge the contribution of the patients who participated in the study. <h3>Disclosure of Interest</h3> None declared