SP0117 Ultrasound scanning of ra patients in remission
Authors: A. Iagnocco
Journal: Annals of the Rheumatic Diseases (2018)

The optimisation of the current therapeutic strategies for RA, with the establishment of early intensive treatment and with the availability of new drugs, has led to a dramatic change in the management of RA, and remission is the target of modern treatment in patients with RA.<sup><sup>1 2</sup></sup> Remission is ideally characterised by the absence of clinically detectable disease activity, the absence of radiographic progression and the improvement of physical function.<sup><sup>3</sup></sup> However, in clinical practice it is frequently difficult to use a comprehensive definition of this condition and apply objective systems for assessing it. Then, subclinical disease activity may be present, even in patients who are in clinical remission, leading to joint damage progression<sup><sup>4</sup></sup> and disease flare.<sup><sup>2 5</sup></sup> EULAR recommendations for the use of imaging in RA patients include ultrasound (US) as an assessment tool for inflammatory activity and remission, as it is able to detect joint inflammation and predict subsequent joint damage.<sup><sup>6</sup></sup> Recent studies have shown that US provides diagnostic and prognostic data in terms of risk of flare, disability and damage progression in RA.<sup><sup>8</sup></sup> Furthermore, in addition to joints, US allows the assessment also of periarticular structures, such as tendons, that have been demonstrated to be the site of inflammatory changes also in patients in clinical remission.<sup><sup>7</sup></sup> Recently, 427 RA patients in clinical remission have been evaluated in a multicentre study which included the US assessment of wrist and hand tenosynovitis and synovitis by grey scale (GS) and power Doppler (PD).<sup><sup>2</sup></sup> Results of this study showed a high prevalence of tenosynovitis (52.5%–95% CI 0.48, 0.57 for GS and 22.7%–95% CI 0.19, 0.27 for PD) and synovitis (71.6%–95% CI 0.67, 0.76 for GS and 42%–95% CI 0.37, 0.47 for PD). Among clinical correlates, PD tenosynovitis associated with lower remission duration and morning stiffness while PD synovitis did not. Only PD tenosynovitis showed a significant association with the flare questionnaire [OR 1.95 (95% CI 1.17, 3.26)]. No cross-sectional associations were found with the HAQ. The presence of radiographic erosions associated with GS and PD synovitis but not with tenosynovitis. This study demonstrated that US-detected tenosynovitis is a frequent finding in RA in clinical remission. Compared with intra-articular synovitis, active tenosynovitis was more associated with RA patients reporting unstable remission. Based on those results, US demonstrated to be a useful imaging modality for assessing tenosynovitis which may help in subsetting RA patients in clinical remission.<sup><sup>2</sup></sup> More recently, a multicentre longitudinal study in 361 consecutive patients with RA in clinical remission demonstrated that the conjunct presence of PD positive tenosynovitis and synovitis predicts flare in patients with RA in clinical remission.<sup><sup>7</sup></sup> US scanning of RA patients in remission has a crucial role in order to demonstrate active joint and tendon inflammation that are able to predict flare. During this practical skills session at , EULAR Congress 2018 the role of US in detecting subclinical inflammation at joint and tendon level will be discussed and practical demonstration on how to scan patients in remission will be performed. <h3>References</h3> [1] Smolen JS, et al. Treating rheumatoid arthritis to target: Recommendations of an international task force. Ann Rheum Dis2010. [2] Bellis E, et al. Ultr asound-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. Rheumatology2016. [3] Felson D. Defining remission in rheumatoid arthritis. Ann Rheum Dis2012. [4] Brown AK, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum2008. [5] Sakellariou G, et al. In patients with early rheumatoid arthritis, the new ACR/EULAR definition of remission identifies patients with persistent absence of functional disability and suppression of ultrasonographic synovitis. Ann Rheum Dis2013. [6] Colebatch AN, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis2013. [7] Filippou G, et al. The predictive role of Ultrasound detected tenosynovitis and joint synovitis for flare in patients with Rheumatoid Arthritis in stable remission. <i>Results of an Italian multicentre study of the Italian Society for Rheumatology Group for Ultrasound: the STARTER study</i>Submitted. [8] Scirè CA, et al. Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology2009. <h3>Disclosure of Interest</h3> None declared