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

Emanuela Bellis, Carlo Alberto Scirè, Greta Carrara, Antonella Adinolfi, Alberto Batticciotto, Alessandra Bortoluzzi, Giovanni Cagnotto, Marta Caprioli, M. Canzoni, Francesco Paolo Cavatorta, O. De Lucia, V. Di Sabatino, Antonella Draghessi, G. Filippou, Ilaria Farina, M. C. Focherini, Alessandra Gabba, M. Gutierrez, Luca Idolazzi, Filippo LuccioliP. Macchioni, Marco Sergio Massarotti, Claudio Mastaglio, Luana Menza, Maurizio Muratore, Simone Parisi, V. Picerno, Matteo Piga, Roberta Ramonda, Bernd Raffeiner, Daniela Rossi, Silvia Rossi, Paola Rossini, Garifallia Sakellariou, Crescenzio Scioscia, C. Venditti, A. Volpe, Marco Matucci-Cerinic, Annamaria Iagnocco

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives. This study aimed to estimate the prevalence of US-detected tenosynovitis in RA patients in clinical remission and to explore its clinical correlates.Methods. A total of 427 RA patients in clinical remission were consecutively enrolled from 25 Italian rheumatology centres. Tenosynovitis and synovitis were scored by US grey scale (GS) and power Doppler (PD) semi-quantitative scoring systems at wrist and hand joints. Complete clinical assessment was performed by rheumatologists blinded to the US results. A flare questionnaire was used to assess unstable remission (primary outcome), HAQ for functional disability and radiographic erosions for damage (secondary outcomes). Cross-sectional relationships between the presence of each US finding and outcome variables are presented as odds ratios (ORs) and 95% CIs, both crude and adjusted for pre-specified confounders.Results. The prevalence of tenosynovitis in clinical remission was 52.5% (95% CI 0.48, 0.57) for GS and 22.7% (95% CI 0.19, 0.27) for PD, while the prevalence of synovitis was 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.Conclusions. US-detected tenosynovitis is a frequent finding in RA patients in clinical remission and associates with unstable remission.

Original languageEnglish
Article numberkew258
Pages (from-to)1826-1836
Number of pages11
JournalRheumatology
Volume55
Issue number10
DOIs
Publication statusPublished - Oct 1 2016

Keywords

  • Flare
  • Remission
  • rheumatoid arthritis
  • Tenosynovitis
  • Ultrasound

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

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