Previous research from investigators at the University of Leeds found that inflammation on ultrasound was predictive of progression in RA patients, but the criteria for remission in that study were less strict, and many of the patients would not have qualified as being in remission by DAS28, Dr. Dohn said.3
In the study at his center, 87 RA patients, in continuous DAS28 remission for at least a year and with no radiographic progression for at least a year, had ultrasound imaging on 24 joints. The joints were scored 0 to 3 for grey-scale synovitis (GSS) and synovial color Doppler activity (CDA). Those with scores of 0 on both for all joints were considered to have no inflammation. And those with a GSS score of 1 but still CDA scores of 0 were considered to have minimal inflammation.
Total absence of inflammation on ultrasound wasn’t seen in any of the patients treated with csDMARDS and in just 14% of those treated with biological DMARDS (P=.01). But the treatment groups showed no statistically significant difference in minimal inflammation, seen in 33% and 40%, respectively. A CDA score of at least 1 in at least one joint was seen in more than half of the patients in both groups.
“So even though they were in DAS remission for a long-standing period and even though they did not have radiographic progression [for a year], we still found active inflammation in the majority of patients,” Dr. Dohn said.
He hopes they will eventually be able to tell whether the inflammation findings can help identify the patients at risk.
“We continue to identify them and see whether they progressed,” he said.
Subclinical Inflammation on MRI in PsA
Researchers in a third study are assembling data in a relatively unexplored area—subclinical inflammation on MRI in the feet of patients with psoriasis—in an effort to find predictors of development of psoriatic arthritis (PsA), said Ashish Mathew, MD, assistant professor at Christian Medical College in Vellore, India.4
Fifty-three patients with psoriasis without arthritis (PsO) and 30 patients with PsA were enrolled, and their feet were imaged with a low-field extremity MRI. Researchers found high percentages of patients with subclinical inflammation; it was seen in 64% of the PsO patients and in 67% of the PsA patients, not a statistically significant difference. They also found that a score of greater than 3 on the Early Arthritis in Psoriasis questionnaire was a predictor of subclinical foot inflammation (P=.008).
