Emanuela Bellis1, Carlo Alberto Scirè2, Greta Carrara2, Antonella Adinolfi3, Alberto Batticciotto4, Alessandra Bortoluzzi5, Giovanni Cagnotto6, Marta Caprioli7, Marco Canzoni8, Francesco Paolo Cavatorta9, Orazio De Lucia10, Valentina Di Sabatino3, Antonella Draghessi11, Georgios Filippou3, Ilaria Farina5, Maria Cristina Focherini12, Alessandra Gabba13, Marwin Gutierrez11, Luca Idolazzi14, Filippo Luccioli15, Pierluigi Macchioni16, Marco Sergio Massarotti17, Claudio Mastaglio18, Luana Menza18, Maurizio Muratore19, Simone Parisi20, Valentina Picerno3, Matteo Piga13, Roberta Ramonda21, Bernd Raffeiner22, Daniela Rossi23, Silvia Rossi6, Paola Rossini24, Garifallia Sakellariou6, Crescenzio Scioscia25, Carlo Venditti26, Alessandro Volpe9, Marco Matucci-Cerinic27, Annamaria Iagnocco28. 1. Rheumatology Unit, Mauriziano Hospital, Turin. 2. Epidemiology Unit, Italian Society for Rheumatology, Milan. 3. Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena. 4. Rheumatology Department, Luigi Sacco University Hospital, Milan. 5. Rheumatology Department, S. Anna di Cona University Hospital, Ferrara. 6. Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo. 7. Medicine Department, Istituti Clinici di Pavia e Vigevano, Pavia. 8. Rheumatology Unit, A.O. Sant'Andrea, Rome. 9. Rheumatology Unit, A.O.U.P. Santa Chiara, Trento. 10. Division and Chair of Rheumatology, Gaetano Pini Orthopaedic Institute, Milan. 11. Rheumatology Department, Clinica Reumatologica, Università Policlinica delle Marche, Jesi. 12. Rheumatology Unit, Infermi Hospital, Rimini. 13. Rheumatology Unit, A.O.U. University Clinic Cagliari, Monserrato. 14. Rheumatology Unit, Ospedale Civile Maggiore, Verona. 15. Rheumatology Unit, A.O.S. Maria della Misericordia, Perugia. 16. Rheumatology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia. 17. Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano. 18. Rheumatology Unit, Moriggia-Pelascini Hospital, Gravedona. 19. A. Galateo Hospital, Rheumatology Unit, San Cesario di Lecce. 20. SC Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin. 21. Rheumatology Unit, Department of Medicine, DIMED, University of Padova, Padova. 22. Rheumatology Unit, Bolzano Hospital, Bolzano. 23. SS Immunoreumatologia, G. Bosco Hospital, Turin. 24. Rheumatology Unit, P.O. Destra Secchia, Pieve di Coriano. 25. DIM Sezione di Reumatologia, Policlinico Universitario di Bari. 26. Rheumatology Unit, A.O. Rummo di Benevento. 27. Rheumatology Unit, University of Florence, Florence. 28. Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy annamaria.iagnocco1@gmail.com.
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.
OBJECTIVES: This study aimed to estimate the prevalence of US-detected tenosynovitis in RApatients in clinical remission and to explore its clinical correlates. METHODS: A total of 427 RApatients 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 RApatients in clinical remission and associates with unstable remission.
Authors: Echoe M Bouta; Richard D Bell; Homaira Rahimi; Lianping Xing; Ronald W Wood; Clifton O Bingham; Christopher T Ritchlin; Edward M Schwarz Journal: Nat Rev Rheumatol Date: 2018-01-11 Impact factor: 20.543
Authors: Kiyomitsu Katsumata; Jun Ishihara; Aslan Mansurov; Ako Ishihara; Michal M Raczy; Eiji Yuba; Jeffrey A Hubbell Journal: Sci Adv Date: 2019-11-06 Impact factor: 14.136