Ultrasound could form an important part of remission assessment in rheumatoid arthritis suggest the authors of a study showing a significant association between power Doppler (PD) activity and disease flares.
The
study of nearly 100 patients with RA in remission who were taking DMARDs found those with ultrasound-detected PD activity at baseline were around four times as likely to experience disease flare than those without.
Over 12 months of assessment, 35% of patients with increased PD activity at baseline experienced flare compared with 11% of those with no PD activity.
Previous research has indicated the link between PD activity and subsequent damage progression, but this was the first to provide evidence of its clinical relevance, the authors wrote in Annals of the Rhematic Diseases.
“In RA patients with clinical remission … PD activity may be the best marker of adverse clinical outcomes,” they wrote, pointing to the high negative predictive value (84%) of PD activity predicting flare.
They argued that imaging criteria based on PD activity may be superior to existing criteria such as SDAI, DAS28, and the 2011 ACR/EULAR in predicting sustained remission.
“Of all the currently available disease activity measurement techniques, a negative PD examination may enable the rheumatologist to be the most confident of sustained disease remission,” they wrote.
Imaging assessment should form part of remission criteria, they suggested.
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