Clinical and sonographic biomarkers of structural damage progression in RA patients in clinical remission: A prospective study with 12 months follow-up

• Published in: Seminars in arthritis and rheumatism Vol. 47; no. 3; pp. 303 - 309
• Main Authors: Ramírez, Julio, MD, Narváez, José Antonio, MD, Ruiz-Esquide, Virginia, MD, Hernández-Gañán, Javier, MD, Cuervo, Andrea, MD, Inciarte-Mundo, José, Hernández, Ma Victoria, MD, Sampayo-Cordero, Miguel, Pablos, José Luis, MD, PhD, Sanmartí, Raimon, MD, Cañete, Juan D., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017
• Subjects: Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - pathology; Biomarkers - blood; Blood Sedimentation; Disease Progression; Edema - diagnostic imaging; Edema - pathology; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Hand Joints - diagnostic imaging; Hand Joints - pathology; Humans; Knee Joint - diagnostic imaging; Knee Joint - pathology; Leukocyte L1 Antigen Complex - blood; Magnetic Resonance Imaging - methods; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prednisone; Prospective Studies; Remission; Remission Induction; Rheumatoid arthritis; Rheumatology; Risk Factors; Synovitis; Synovitis - blood; Synovitis - diagnostic imaging; Synovitis - pathology; Ultrasonography - methods; Ultrasound; CRP; Synovitis; magnetic resonance imaging; C-reactive protein; MRI; PRF; basic fibroblast growth factor; UdAS; DMARDs; ACPA; power-doppler; Ultrasound defined Active Synovitis; SH; rheumatoid factor; Rheumatoid Arthritis Magnetic Resonance Imaging Score; Remission; RAMRIS; interleukin; metacarpophalangeal; Ultrasound; BMI; Body Mass Index; erythrocyte sedimentation rate; DAS28; IL; Rheumatoid Arthritis; ESR; CI; synovial hypertrophy; bFGF; 28-joint Disease Activity Score; pulse repetition frequency; RA; anti-citrullinated peptide/protein antibodies; CCP2-ELISA; PD; RF; Anti-Cyclic Citrullinated Peptide-Enzyme-Linked ImmunoSorbent Assay; disease-modifying antirheumatic drugs; confidence intervals; MCP; Rheumatoid arthritis
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2017.04.007

Abstract Objective To determine clinical and sonographic biomarkers predicting structural damage progression at 12 months of follow-up as measured by magnetic resonance imaging (MRI) in rheumatoid arthritis (RA) patients in clinical remission. Patients and Methods We included patients with RA in clinical remission, defined as 28-joint disease activity score (DAS28)-erythrocyte sedimentation rate (ESR) <2.6 for > 6 months. Ultrasound scans of both hands and knees and MRI of the dominant hand were performed at baseline and at 12 months. Results Forty-two out of 55 patients completed follow-up. 78% female, aged (median) 54 years; disease duration 93 months. Twelve (28%) patients were taking oral prednisone, 34 (81%) conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), and 20 (47%) biological therapies. At baseline, 45% fulfilled criteria previously defined for ultrasound defined active synovitis (UdAS) (PD [Power Doppler] signal+.synovial hyperplasia > 2). Multivariate analysis showed significant associations between baseline MRI erosion score, body mass index (BMI), disease duration, prednisone treatment, absence of biologic and csDMARDs, UdAS and MRI erosion score progression after 12 months. In an exploratory analysis, serum levels of calprotectin correlated significantly with bone oedema progression. Conclusions We identified clinical and sonographic markers of structural damage progression after 12 months follow-up in patients with RA in clinical remission. Meeting the criteria of ultrasound active synovitis, defined as simultaneous relevant synovial hyperplasia and PD, was associated with erosion progression after 12 months. Calprotectin was associated with bone oedema, in an exploratory analysis.