Santiago Ruta1,2, Josefina Marin3,4, Maria Laura Acosta Felquer3,4, Leandro Ferreyra-Garrot3,4, Javier Rosa3,4, Ricardo García-Monaco3,4, Enrique R Soriano3,4. 1. From the Rheumatology Unit, Internal Medicine Service, and Radiology Department, Hospital Italiano de Buenos Aires; University Institute from Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina. santiago.ruta@hospitalitaliano.org.ar. 2. S. Ruta, MD, MSc, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; M.L. Acosta Felquer, MD, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; J. Rosa, MD, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; R. García-Monaco, MD, Radiology Department, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; E.R. Soriano, MD, MSc, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires. santiago.ruta@hospitalitaliano.org.ar. 3. From the Rheumatology Unit, Internal Medicine Service, and Radiology Department, Hospital Italiano de Buenos Aires; University Institute from Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina. 4. S. Ruta, MD, MSc, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; M.L. Acosta Felquer, MD, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; J. Rosa, MD, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; R. García-Monaco, MD, Radiology Department, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires; E.R. Soriano, MD, MSc, Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, and the University Institute from Hospital Italiano de Buenos Aires.
Abstract
OBJECTIVE: Power Doppler ultrasound (PDUS) has been shown to detect subclinical synovitis in psoriatic arthritis (PsA), but its value is not yet fully understood. The aim of this study was to evaluate PDUS features at joint level in patients with PsA in clinical remission and to investigate its value for predicting short-term flares. METHODS: Consecutive patients with PsA in clinical remission according to the attending rheumatologist and who fulfill minimal disease activity criteria and/or 28-joint Disease Activity Score in remission criteria underwent PDUS examination of 18 joints. All patients were followed up for 6 months. Disease flare was defined as any increase of disease activity generating the need of any of the following changes in therapy with disease-modifying antirheumatic drugs (DMARD) by the attending rheumatologist: dose increase, switch or addition of a different DMARD, and/or switch or addition of biological therapies. RESULTS: Among 54 patients with PsA in clinical remission, 15 (27.8%) experienced a flare within the next 6 months. Twenty patients had at least 1 joint with PDUS synovitis at baseline, and 13 (65%) of these had a disease flare during the followup period compared with only 2 of the 34 patients (5.9%) without baseline PDUS synovitis (relative risk = 11, 95% CI 2.8-44, p < 0.001). On logistic regression analysis, the only variables associated with short-term flares were baseline PDUS synovitis and the use of nonbiologic DMARD. CONCLUSION: Among patients with PsA in clinical remission, PDUS-detected synovitis was a strong predictor of short-term flare of the disease.
OBJECTIVE: Power Doppler ultrasound (PDUS) has been shown to detect subclinical synovitis in psoriatic arthritis (PsA), but its value is not yet fully understood. The aim of this study was to evaluate PDUS features at joint level in patients with PsA in clinical remission and to investigate its value for predicting short-term flares. METHODS: Consecutive patients with PsA in clinical remission according to the attending rheumatologist and who fulfill minimal disease activity criteria and/or 28-joint Disease Activity Score in remission criteria underwent PDUS examination of 18 joints. All patients were followed up for 6 months. Disease flare was defined as any increase of disease activity generating the need of any of the following changes in therapy with disease-modifying antirheumatic drugs (DMARD) by the attending rheumatologist: dose increase, switch or addition of a different DMARD, and/or switch or addition of biological therapies. RESULTS: Among 54 patients with PsA in clinical remission, 15 (27.8%) experienced a flare within the next 6 months. Twenty patients had at least 1 joint with PDUS synovitis at baseline, and 13 (65%) of these had a disease flare during the followup period compared with only 2 of the 34 patients (5.9%) without baseline PDUS synovitis (relative risk = 11, 95% CI 2.8-44, p < 0.001). On logistic regression analysis, the only variables associated with short-term flares were baseline PDUS synovitis and the use of nonbiologic DMARD. CONCLUSION: Among patients with PsA in clinical remission, PDUS-detected synovitis was a strong predictor of short-term flare of the disease.
Authors: Xenofon Baraliakos; Philip G Conaghan; Maria-Antonietta D'Agostino; Walter Maksymowych; Esperanza Naredo; Mikkel Ostergaard; Georg Schett; Paul Emery Journal: Eur J Rheumatol Date: 2019-01