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Micheroli R, Scherer A, Bürki K, Zufferey P, Nissen MJ, Brulhart L, Möller B, Ziswiler HR, Ciurea A, Tamborrini G. Does tenosynovitis of the hand detected by B-mode ultrasound predict loss of clinical remission in rheumatoid arthritis? Results from a real-life cohort. J Ultrason 2022; 22:e21-e27. [PMID: 35449701 PMCID: PMC9009346 DOI: 10.15557/jou.2022.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
Objective The role of US-detected tenosynovitis (USTS) in the management of rheumatoid arthritis remains controversial. The aim of this study was to investigate whether tenosynovitis can predict a flare in rheumatoid arthritis patients in remission in a real-life cohort. Methods Rheumatoid arthritis patients from the Swiss Clinical Quality Management cohort were included in this study if they were in clinical remission, defined by 28-joint disease activity score (DAS28-ESR) <2.6, and had an available B-mode tenosynovitis score. The patients were stratified according to the presence or absence of tenosynovitis (USTS+ vs. USTS–). Cox proportional hazard models were used for time-to-event analysis until the loss of remission, after adjustment for multiple confounders. The impact of baseline US performed early in remission and the advent of flares at different fixed time periods after baseline were investigated in sensitivity analysis. Results Tenosynovitis was detected in 10% of 402 rheumatoid arthritis patients in remission. At baseline, USTS+ patients in remission had significantly higher DAS28-ESR (mean (SD): USTS– 1.8 (0.5) versus USTS+ 2.0 (0.5); p = 0.0019) and higher additional disease activity parameters, such as physician global assessment, and simplified- and clinical-disease activity index. Joint synovitis detected by B-mode US was associated with tenosynovitis (mean (SD) 7.2 (6.3) in USTS– versus 9.0 (5.4) in USTS+, respectively; p = 0.02). A disease flare was observed in 69% of remission phases, with no differences in the time to loss of remission between USTS+ and USTS– groups. Conclusion While US-detected tenosynovitis was associated with higher disease activity parameters in rheumatoid arthritis patients in clinical remission, it was not able to predict a flare.
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Affiliation(s)
- Raphael Micheroli
- Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland
| | - Almut Scherer
- Statistics Group, SCQM Foundation, Zurich, Switzerland
| | - Kristina Bürki
- Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland
| | - Pascal Zufferey
- Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Laure Brulhart
- Department of Rheumatology, Réseau hospitalier neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Burkhard Möller
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern, Switzerland
| | | | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland
| | - Giorgio Tamborrini
- Ultrasound Center UZR, Basel Switzerland and Department of Rheumatology, University Hospital, Basel, Switzerland
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Hèctor C, Millan AM, Diaz-Torne C. Rheumatoid Arthritis: Defining Clinical and Ultrasound Deep Remission. Mediterr J Rheumatol 2021; 31:384-388. [PMID: 33521569 PMCID: PMC7841096 DOI: 10.31138/mjr.31.4.384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/04/2022] Open
Abstract
The prognosis of patients with rheumatoid arthritis (RA) has improved substantially in the last two decades due to the appearance of biological therapies, but above all, due to the improvement in the strategy and management of the disease. Our goal in RA should be to achieve remission, or in its absence, the lowest inflammatory activity. Achieving remission will prevent from structural and functional damage highly associated with RA itself. Clinical remission is defined as the absence of significant signs and symptoms of inflammatory disease activity, as well as the abrogation of any signs of systemic inflammation. Currently, there are some controversies about remission. Which is the real remission? Which remission criteria should be used and when? Does clinical remission mean ultrasound remission? In the present review, we try to answer and put some light into it, focusing on clinical and ultrasound deep remission.
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Affiliation(s)
- Corominas Hèctor
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Milena Millan
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cesar Diaz-Torne
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
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Ranganath VK, Hammer HB, McQueen FM. Contemporary imaging of rheumatoid arthritis: Clinical role of ultrasound and MRI. Best Pract Res Clin Rheumatol 2020; 34:101593. [PMID: 32988757 DOI: 10.1016/j.berh.2020.101593] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) are sensitive imaging modalities used by clinicians to assist in decision-making in the management of rheumatoid arthritis (RA). This review will examine the utility of MRI and MSUS in diagnosing RA, predicting RA flares, tapering therapy, assessing remission, and examining difficult periarticular features. We will also outline the strengths and weaknesses of utilizing MRI and MSUS as outcome measures in the management of RA.
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Affiliation(s)
- Veena K Ranganath
- University of California, David Geffen School of Medicine, Los Angeles, USA.
| | - Hilde B Hammer
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
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Terslev L, Hammer HB. Ultrasound may improve patient care. Clin Rheumatol 2020; 39:1715-1717. [PMID: 32358662 DOI: 10.1007/s10067-020-05071-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Lene Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology, Spine Diseases, Rigshospitalet-Glostrup, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. .,Center for Rheumatology and Spinal Diseases, Copenhagen University Hospital, Rigshsopitalet, Nordre Ringvej 57, 2600, Glostrup, Copenhagen, Denmark.
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Zufferey P, Courvoisier DS, Nissen MJ, Möller B, Brulhart L, Ziswiler HR, Tamborrini G, Ciurea A, D'Agostino MA, Finckh A. Discordances between clinical and ultrasound measurements of disease activity among RA patients followed in real life. Joint Bone Spine 2019; 87:57-62. [PMID: 31557525 DOI: 10.1016/j.jbspin.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/11/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Measurements of disease activity, such as the clinical disease activity score (DAS28) or ultrasound (US) scores, often yield discordant results. This study's objectives were to determine the proportion of disagreements between the two assessment methods in patients with rheumatoid arthritis (RA) and to describe factors associated with discrepancy in assessment. METHODS All RA patients in the Swiss registry for inflammatory arthritides (SCQM) with at least one concomitant DAS28 and US score, were included. Disease activity was categorized as remission, low-to-moderate, and high, based on previously established cut-offs, for both the DAS28 and the US score. A longitudinal analysis was performed among patients who underwent at least two assessments. RESULTS Of 2369 assessments included (1091 patients), 1196 (50.4%) were discordant. The US score both over- and under-estimated disease activity compared to the DAS28 score (23.5% and 26.8% respectively). Clinical and demographic factors significantly associated with discordant results were the individual components of the DAS28 score when US was used as the reference and age, disease duration, and the swollen joint count when the DAS28 was used as the reference. The main US-related factor associated with discordance was the presence of US tenosynovitis. In the longitudinal analysis of 1081 patients, the proportion of disagreements remained essentially unchanged. CONCLUSION Rates of disagreement between clinical and US assessments of disease activity among RA patients are high and remain high during follow-up, even when the US assessors were aware of the clinical examination findings. Both clinical- and ultrasound- related factors were associated with discordances.
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Affiliation(s)
| | | | | | | | - Laure Brulhart
- Hôpital neuchatelois, La chaud de fonds 2300, Switzerland
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Real-world evidence in rheumatic diseases: relevance and lessons learnt. Rheumatol Int 2019; 39:403-416. [PMID: 30725156 DOI: 10.1007/s00296-019-04248-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022]
Abstract
An emerging trend in the medical literature, including the Rheumatology literature, is that of accumulating large, multicentric, multi-national data based on registries of patients seen in real life situations. Such real-world evidence (RWE) may help provide valuable insights into the long-term outcomes of disease in unselected patients seen in daily practice, including patients belonging to vulnerable populations such as extremes of age, during pregnancy and lactation. Evidences gathered from real life practice settings can help understand drug prescription patterns, including adherence to treatment guidelines, cost-effectiveness of therapy, and real-life long-term outcomes, and adverse effects of treatment with particular medications. Registry-based data also helps analyze comorbidities in patients with rheumatic diseases, and their impact on quality of life, morbidity and mortality. Traditionally, a randomized controlled trial (RCT), or systematic reviews of multiple, homogenous RCTs, have been considered the cornerstone of evidence-based medicine, and RWE does, at times, provide differing viewpoints from the results of particular drugs in clinical trial settings. Therefore, in the present day, it is prudent to consider the complementary nature of information derived from RWE to that obtained from rigorous, clinical trial settings. Future guidelines for disease management may consider it relevant to include information from RWE in addition to that available from clinical trials, to help devise management guidelines that are harmonious with routine practice settings.
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Kaeley GS, Ranganath VK. Chasing the Ghost of Imaging Remission in Rheumatoid Arthritis. J Rheumatol 2018; 45:881-883. [PMID: 29961675 DOI: 10.3899/jrheum.180035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Gurjit S Kaeley
- University of Florida College of Medicine, Jacksonville, Florida;
| | - Veena K Ranganath
- University of California at Los Angeles, Los Angeles, California, USA
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Gremese E, Fedele AL, Alivernini S, Ferraccioli G. Ultrasound assessment as predictor of disease relapse in children and adults with arthritis in clinical stable remission: new findings but still unmet needs. Ann Rheum Dis 2018; 77:1391-1393. [PMID: 29860230 PMCID: PMC6161664 DOI: 10.1136/annrheumdis-2018-212941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Elisa Gremese
- Division of Rheumatology, IRCCS-Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, IRCCS-Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Alivernini
- Division of Rheumatology, IRCCS-Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy
| | - Gianfranco Ferraccioli
- Division of Rheumatology, IRCCS-Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy
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