Salmeen et al., 2011

Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments

At a glance

Objective

To test wheter considering ultrasound measurements allow for the definition of stricter remission criteria, which ensure that patients in remission are free of synovitis.

Related articles

For other articles casting doubt on the validity of the DAS28, see Lee et al., 2011.

Link

DOI: https://doi.org/10.1136/ard.2010.134445

Background

Methods

• Sample included patients with DAS28 \(\leq\) 2.6 (implies DAS28ESR was used) for at least 6 months
• These patients were classified using standard DAS28-, more stringent DAS28-, and SDAI cutoffs
• Records of ultrasound were made to compare against clinical disease activity measures

Results

• 128 patients receiving either DMARD or DMARD and TNFi were included (median DAS28ESR 1.7, all < 2.6)
• Of 640 imaged joints, 5% had moderate or severe power Doppler (PD) activity, 8% were clinically swollen, 1% were tender
• Moderate to severe PD activity was present in patients fulfilling DAS28ESR (21%), ACR (15%) or SDAI (19%) remission
• More stringent DAS28ESR and SDAI criteria reduced the mean number of swollen and tender joints, but not the percentage of patients with PD activity

Conclusions

• Using more stringent remission criteria reduces symptoms of inflammation, but not PD activity in patients with remission
• Clinical criteria may be sufficiently insensitive (?) to detect low but clinically relevant levels of inflammation accurately