Rheumatology & Autoimmunity (Sep 2021)
Subclinical synovitis detected by magnetic resonance imaging and ultrasonography following clinical remission in patients with rheumatoid arthritis: A retrospective study
Abstract
Abstract Background Subjective residual symptoms persist after clinical remission of rheumatoid arthritis (RA) in Japanese patients. Few studies have examined the relationship between these symptoms and subclinical inflammation using high‐sensitivity imaging (musculoskeletal ultrasound [MSUS] and magnetic resonance imaging [MRI]). We examined the relationship between subjective residual symptoms and imaging findings in patients with RA who achieved clinical remission. Methods We enrolled 30 patients with RA. The primary endpoint was the patients' subjective residual symptoms. The secondary endpoint was the relationship between the aforementioned symptoms and imaging findings. Results Despite a mean Simplified Disease Activity Index of 1.3, imaging evaluation revealed inflammatory findings. In the multivariate analysis, the Health Assessment Questionnaire Disability Index (HAQ‐DI) and pain visual analog scale (VAS) scores were extracted as independent related factors of subjective residual symptoms. The stratified analysis according to HAQ‐DI showed a significant difference in synovitis on MRI between patients with and without residual disability (12.0 ± 8.7 vs. 5.3 ± 5.3, respectively; p = 0.0192). However, MSUS scores showed no significant difference in these two groups. In addition, no significant differences were found in MSUS and MRI scores between patients with and without residual pain VAS. Conclusions Our findings demonstrated residual synovitis related to patient‐reported outcomes in patients with RA who achieved clinical remission. In particular, patients with an HAQ‐DI score of >0.25 even after achieving clinical remission should be further examined by MRI and/or MSUS for the evaluation of residual synovitis.
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