TY - JOUR
T1 - The ability of synovitis to predict structural damage in rheumatoid arthritis
T2 - a comparative study between clinical examination and ultrasound
AU - Dougados, Maxime
AU - Devauchelle-Pensec, Valérie
AU - Ferlet, Jean François
AU - Jousse-Joulin, Sandrine
AU - D'Agostino, Maria-Antonietta
AU - Backhaus, Marina
AU - Bentin, Jacques
AU - Chalès, Gérard
AU - Chary-Valckenaere, Isabelle
AU - Conaghan, Philip
AU - Wakefield, Richard J
AU - Etcheparre, Frédéric
AU - Gaudin, Philippe
AU - Grassi, Walter
AU - Heijde, Désirée van der
AU - Mariette, Xavier
AU - Naredo, Esperanza
AU - Szkudlarek, Marcin
PY - 2013/5
Y1 - 2013/5
N2 - OBJECTIVES: To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA).METHODS: Patients with RA.STUDY DESIGN: Prospective, 2-year follow-up.DATA COLLECTED: Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2.ANALYSIS: Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis.RESULTS: Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36-2.98) p<0.001 versus 1.61 (1.06-2.45) p=0.026 versus 1.75 (1.18-2.58) p=0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR=2.16 (1.16-4.02) p=0.015 and 3.50 (1.77-6.95) p<0.001 for US-GS and US-PD and 2.79 (1.35-5.76) p=0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression.CONCLUSIONS: This study confirms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.
AB - OBJECTIVES: To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA).METHODS: Patients with RA.STUDY DESIGN: Prospective, 2-year follow-up.DATA COLLECTED: Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2.ANALYSIS: Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis.RESULTS: Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36-2.98) p<0.001 versus 1.61 (1.06-2.45) p=0.026 versus 1.75 (1.18-2.58) p=0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR=2.16 (1.16-4.02) p=0.015 and 3.50 (1.77-6.95) p<0.001 for US-GS and US-PD and 2.79 (1.35-5.76) p=0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression.CONCLUSIONS: This study confirms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.
KW - Adult
KW - Aged
KW - Arthritis, Rheumatoid/diagnostic imaging
KW - Disease Progression
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Joints/diagnostic imaging
KW - Longitudinal Studies
KW - Male
KW - Middle Aged
KW - Physical Examination/standards
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Reproducibility of Results
KW - Risk Factors
KW - Synovitis/diagnostic imaging
KW - Ultrasonography, Doppler/standards
U2 - 10.1136/annrheumdis-2012-201469
DO - 10.1136/annrheumdis-2012-201469
M3 - Article
C2 - 22679298
SN - 0003-4967
VL - 72
SP - 665
EP - 671
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 5
ER -