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Nearly half of RA patients in remission had active synovitis
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Almost 50% of patients with rheumatoid arthritis in clinical remission had active synovitis as determined through ultrasound and higher disease activity compared with patients without active synovitis, according to recent study results.
Researchers in Spain studied 55 patients with rheumatoid arthritis (RA; median age, 52 years; 76.4% women) in clinical remission, which was determined by two independent rheumatologists as Disease Activity Score 28 (DAS28)-erythrocyte sedimentation rate (ESR)<2.6 for more than 6 months. A sonographer performed power Doppler ultrasound (PDUS) of the knees and hands, and synovial hypertrophy (SH) and PDUS signal were scored on grades 0 to 3.
Twenty-five patients (45.4%) met active synovitis criteria, defined as SH≥2 and a PDUS signal. Those patients had higher DAS28-C reactive protein (P=.023), DAS28-ESR (P=.06), Simplified Disease Activity Index (SDAI) score (P=.064) compared with patients without active synovitis. Forty percent of patients without active synovitis were taking oral glucocorticoids (≤5 mg daily) compared with 12% of patients with active synovitis (P=.044).
“Patients with synovitis also had significantly higher serum levels of the angiogenic biomarkers angiopoietin-2 (P=.038), vascular endothelial growth factor-D (P=.018), placental growth factor (P=.043), stromal cell-derived factor-1 (P=.035), matrix metallopeptidase-2 (P=.027) and basic fibroblast growth factor (bFGF; P=.007), but not of pro-inflammatory cytokines,” the researchers reported.
Serum levels of bFGF, DAS28-ESR and being glucocorticoid-naive best predicted active synovitis, according to a multivariate logistic regression model. The model’s predictive indices showed a specificity of 73.3%; sensitivity of 72% and AUC of 81.5% (95% CI, 70.1%-92.8%).
“This study found that 45% of RA patients with stringent clinical remission criteria had ultrasound-defined active synovitis,” the researchers concluded. “These patients had significantly higher levels of angiogenic biomarkers, especially bFGF, which correlated with different clinical and serological variables. These findings suggest it may be possible to find surrogate serum biomarkers of active synovitis that could be useful in the follow-up of patients with RA in remission.”
Disclosure: The researchers report no relevant financial disclosures.
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