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Power Doppler ultrasound-detected synovitis may predict flare in PsA cases in clinical remission
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Power Doppler ultrasound-detected synovitis is strongly predictive of short-term psoriatic arthritis flare among patients in clinical remission, according to findings.
Researchers evaluated 52 consecutive patients with psoriatic arthritis based on the CASPAR criteria and who were in clinical remission. A musculoskeletal examination was conducted and a
rheumatologist with experience in ultrasound (US) conducted imaging assessments on the same day as clinical assessment. The rheumatologist was blinded to the clinical data and evaluated 18 joints per patient. Follow-up continued for 6 months to monitor disease flares.
At baseline, 30 patients demonstrated joint cavity widening due to synovial fluid and/or synovial hypertrophy in at least one joint. Synovitis with power doppler (PD) grade of at least 1 in at least one examined joint was detected in 20 patients. Of these 20 patients, eight had one joint with a PD signal. The remaining 12 patients had two or more joints with positive PD signal. Of the total 972 joints evaluated, 38 demonstrated abnormal vascularization. In 19 of these joints PD grade 1 was detected; in 17 joints PD grade 2 was detected; and in two joints PD grade 3 was identified. The wrist was the most frequently involved joint (34.2%).
esearchers found that during the follow-up period, disease flare occurred in 15 of the 54 patients. Of these 15 flares, 11 included inflammatory articular involvement; three were characterized by both inflammatory articular and anthesis involvement; and one included the presence of dactylitis. Compared with patients who did not have a flare, patients who did were significantly older and more frequently treated with disease-modifying antirheumatic drugs.
PD grade of at least 1 at baseline was seen in at least one joint in 20 patients, and 13 of these patients experienced a flare during follow-up. Two of the 34 patients without baseline US synovitis and with PD grade of at least one had a disease flare during follow-up (relative risk = 11).
Intra-articular PD signal at baseline had 87% sensitivity for the detection of flare and 82% specificity.
“The presence of US synovitis with positive PD signal despite clinical remission suggests that flares may be related to an incomplete suppression of inflammation, undetectable by the clinical indices used in daily rheumatology practice,” the researchers wrote. “Therefore, once the patients have achieved clinical remission, an US examination of PD technique could predict the probability of remaining in remission.” -by Jennifer Byrne
Disclosure s : The researchers report no relevant disclosures.
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