The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound

To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA). Patients with RA. Prospective, 2-year follow-up. Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 m...

Full description

Saved in:

Bibliographic Details
Published in:	Annals of the rheumatic diseases Vol. 72; no. 5; p. 665
Main Authors:	Dougados, Maxime, Devauchelle-Pensec, Valérie, Ferlet, Jean François, Jousse-Joulin, Sandrine, D'Agostino, Maria-Antonietta, Backhaus, Marina, Bentin, Jacques, Chalès, Gérard, Chary-Valckenaere, Isabelle, Conaghan, Philip, Wakefield, Richard J, Etchepare, Fabien, Etcheparre, Frédéric, Gaudin, Philippe, Grassi, Walter, Heijde, Désirée van der, Mariette, Xavier, Naredo, Esperanza, Szkudlarek, Marcin
Format:	Journal Article
Language:	English
Published:	England 01-05-2013
Subjects:	Adult Aged Arthritis, Rheumatoid - diagnostic imaging Arthritis, Rheumatoid - epidemiology Arthritis, Rheumatoid - pathology Disease Progression Female Follow-Up Studies Humans Joints - diagnostic imaging Joints - pathology Longitudinal Studies Male Middle Aged Physical Examination - standards Predictive Value of Tests Prospective Studies Reproducibility of Results Risk Factors Synovitis - diagnostic imaging Synovitis - epidemiology Synovitis - pathology Ultrasonography, Doppler - standards
Online Access:	Get more information
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA). Patients with RA. Prospective, 2-year follow-up. 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. 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. 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. 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.
ISSN:	1468-2060
DOI:	10.1136/annrheumdis-2012-201469