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A reduced 12-joint ultrasound examination predicts lack of X-ray progression better than clinical remission criteria in patients with rheumatoid arthritis

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Abstract

To study the predictive value of clinical remission definitions and ultrasound (US) examination on X-ray progression in rheumatoid arthritis (RA). This was an observational prospective multicenter 1-year follow-up cohort of RA patients with moderate disease activity (3.2 < DAS28 ≤ 5.1) who started anti-TNF therapy. DAS28ESR, DAS28CRP, SDAI, CDAI, and ACR/EULAR remission criteria were applied and reduced 12-joint US examination was performed at baseline and at 6 and 12 months. At baseline and month 12, radiographs of hands and feet were obtained in a subset of patients. A blind independent reader scored radiographs. X-ray progression was defined as Sharp van der Heijde change score >1 and no progression was defined as ≤0. 319 of 357 patients completed the study; patients had a mean (SD) age of 53.5 (13.1) years, with a disease duration of 7.5 (7.1) years. Laboratory, clinical, and US values significantly improved at month 6, except CRP, with additional improvement at month 12. Remission and low disease activity rates increased at follow-up. In the subset of 115 patients with radiological studies, clinical remission by any definition was not significantly associated with X-ray progression. Patients without PD signal at baseline and month 6 were a lower risk of X-ray progression than patients with PD signal, OR 0.197 (95% CI 0.046–0.861) and 0.134 (95% CI 0.047–0.378), respectively. Absence of PD signal, but not clinical remission predicts lack of X-ray progression. A feasible 12-joint US examination may add relevant information to RA remission criteria.

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References

  1. Smolen JS, Landewé R, Breedveld FC et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73:492–509

    Article  CAS  PubMed  Google Scholar 

  2. Felson DT, Smolen JS, Wells G et al (2011) American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis 70:404–413

    Article  PubMed  Google Scholar 

  3. Bykerk VP, Massarotti EM (2012) The new ACR/EULAR remission criteria: rationale for developing new criteria for remission. Rheumatology 51(suppl 6):vi16–vi20

    PubMed  Google Scholar 

  4. Prevoo ML, van’t Hof MA, Kuper HH et al (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48

    Article  CAS  PubMed  Google Scholar 

  5. Smolen JS, Breedveld FC, Schiff MH et al (2003) A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology 42:244–257

    Article  CAS  PubMed  Google Scholar 

  6. Khanna D, Oh M, Furst DE et al (2007) Evaluation of the preliminary definitions of minimal disease activity and remission in an early seropositive rheumatoid arthritis cohort. Arthritis Rheum 57:440–447

    Article  PubMed  Google Scholar 

  7. Mulherin D, Fitzgerald O, Bresnihan B (1996) Clinical improvement and radiological deterioration in rheumatoid arthritis: evidence that the pathogenesis of synovial inflammation and articular erosion may differ. Br J Rheumatol 35:1263–1268

    Article  CAS  PubMed  Google Scholar 

  8. Molenaar ET, Voskuyl AE, Dinant HJ et al (2004) Progression of radiologic damage in patients with rheumatoid arthritis in clinical remission. Arthritis Rheum 50:36–42

    Article  PubMed  Google Scholar 

  9. Brown AK, Conaghan PG, Karim Z et al (2008) An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 58:2958–2967

    Article  CAS  PubMed  Google Scholar 

  10. Cohen G, Gossec L, Dougados M et al (2007) Radiological damage in patients with rheumatoid arthritis on sustained remission. Ann Rheum Dis 66:358–363

    Article  CAS  PubMed  Google Scholar 

  11. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  CAS  PubMed  Google Scholar 

  12. Rodríguez-Valverde V, Cáliz Cáliz R, Alvaro-Gracia Alvaro JM et al (2006) III Actualización del Consenso de la Sociedad Española de Reumatología sobre terapia biológica en la artritis reumatoide. Reumatol Clin 2(suppl 2):S52–S59

    Article  PubMed  Google Scholar 

  13. Esteve-Vives J, Batlle-Gualda E, Reig A (1993) Spanish version of the Health Assessment Questionnaire: reliability, validity and transcultural equivalency. J Rheumatol 20:2116–2122

    CAS  PubMed  Google Scholar 

  14. Naredo E, Rodríguez M, Campos C et al (2008) Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 59:515–522

    Article  PubMed  Google Scholar 

  15. Szkudlarek M, Court-Payen M, Jacobsen S et al (2003) Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 48:955–962

    Article  PubMed  Google Scholar 

  16. van der Heijde DM, van Leeuwen MA, van Riel PL et al (1992) Biannual radiographic assessment of hand and feet in a three-year prospective follow-up of patients with early rheumatoid arthritis. Arthritis Rheum 35:26–34

    Article  PubMed  Google Scholar 

  17. van der Heijde D, Boonen A, Boers M et al (1999) Reading radiographs in chronological order, in pairs or as single films has important implications for the discriminative power of rheumatoid arthritis clinical trials. Rheumatology (Oxford) 38:1213–1220

    Article  Google Scholar 

  18. Pinals RS, Masi AT, Larsen RA (1981) Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum 24:1308–1315

    Article  CAS  PubMed  Google Scholar 

  19. Van Tuy LH, Felson DT, Wells G et al (2010) Evidence for predictive validity of remission on long-term outcome in rheumatoid arthritis: a systematic review. Arthritis Care Res 62:108–117

    Article  Google Scholar 

  20. Alehata D, Ward MM, Machold KP et al (2005) Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum 52:2625–2636

    Article  Google Scholar 

  21. Mierau M, Schoels M, Gonda G et al (2007) Assessing remission in clinical practice. Rheumatology 46:975–979

    Article  CAS  PubMed  Google Scholar 

  22. Van der Heidje D, Klareskog L, Boers M et al (2005) Comparison of different definitions to classify remission and sustained remission: 1 year TEMPO results. Ann Rheum Dis 64:1582–1587

    Article  Google Scholar 

  23. Smolen JS, Aletaha D (2008) Activity assessments in rheumatoid arthritis. Curr Opin Rheumatol 20:306–313

    Article  PubMed  Google Scholar 

  24. Balsa A, de Miguel E, Castillo C et al (2010) Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology 49:683–690

    Article  PubMed  Google Scholar 

  25. Brown AK, Quinn MA, Karim Z et al (2006) Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying drug-induced remission: evidence from an imaging study explain structural progression. Arthritis Rheum 54:3761–3773

    Article  CAS  PubMed  Google Scholar 

  26. Kirwan JR (2004) The synovium in rheumatoid arthritis: evidence for (at least) two pathologies. Arthritis Rheum 50:1–4

    Article  PubMed  Google Scholar 

  27. Kawashiri SY, Suzuki T, Nakashima Y et al (2014) Synovial inflammation assessed by ultrasonography correlates with MRI-proven osteitis in patients with rheumatoid arthritis. Rheumatology 53:1452–1456

    Article  CAS  PubMed  Google Scholar 

  28. Saleem B, Brown AK, Quinn M et al (2012) Can flare be predicted in DMARD treated RA patients in remission, and is it important? A cohort study. Ann Rheum Dis 71:1316–1321

    Article  PubMed  Google Scholar 

  29. McQueen F, Naredo E (2011) The ‘disconnect’ between synovitis and erosion in rheumatoid arthritis: a result of treatment or intrinsic to the disease process itself? Ann Rheum Dis 70:241–244

    Article  PubMed  Google Scholar 

  30. Dale J, Stirling A, Zhang R et al (2016) Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial. Ann Rheum Dis 75(6):1043–1050

    Article  PubMed  Google Scholar 

  31. Haavardsholm EA, Aga AB, Olsen IC et al (2016) Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial. BMJ 16(354):i4205

    Article  Google Scholar 

  32. Koga T, Okada A, Fukuda T et al (2016) Prognostic factors toward clinically relevant radiographic progression in patients with rheumatoid arthritis in clinical practice: A Japanese multicenter, prospective longitudinal cohort study for achieving a treat-to-target strategy. Medicine (Baltimore) 95:e3476

    Article  PubMed  PubMed Central  Google Scholar 

  33. van der Heijde D (2012) Remission by imaging in rheumatoid arthritis: should this be the ultimate goal? Ann Rheum Dis 71(suppl 2):i89–i92

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

AbbVie Spain sponsored the study; contributed to its design; participated in the collection, analysis, and interpretation of the data, and in the writing, reviewing, and approval of the final manuscript. Statistical and medical writing support was provided by Jesus Garrido. The study was approved by the ethic committee of the Hospital Universitario La Paz (HULP: PI-976; 21/2009) in agreement with National and International rules. This study was funded by Abbvie (Grant Number SCI-SPAI-2008-08).

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Authors and Affiliations

  1. Rheumatology Department, Hospital Universitario La Paz, Pº de la Castellana 261, 28046, Madrid, Spain

    Eugenio de Miguel

  2. Rheumatology Department, Hospital Universitario Miguel Servet, Saragossa, Spain

    Angela Pecondón-Español

  3. Rheumatology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

    Manuel Castaño-Sánchez

  4. Rheumatology Department, Hospital Marqués de Valdecilla, Santander, Spain

    Alfonso Corrales

  5. Rheumatology Department, Hospital de Navarra, Pamplona, Spain

    Ricardo Gutierrez-Polo

  6. Rheumatology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain

    Manuel Rodriguez-Gomez

  7. Rheumatology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain

    Jose A. Pinto-Tasende

  8. Medical Department, AbbVie, Madrid, Spain

    Jose L. Rivas

  9. Rheumatology Department, Hospital La Fe, Valencia, Spain

    José Ivorra-Cortés

Authors
  1. Eugenio de Miguel
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  2. Angela Pecondón-Español
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  3. Manuel Castaño-Sánchez
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  4. Alfonso Corrales
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  5. Ricardo Gutierrez-Polo
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  6. Manuel Rodriguez-Gomez
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  7. Jose A. Pinto-Tasende
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  8. Jose L. Rivas
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  9. José Ivorra-Cortés
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Consortia

The ECO-DAI Group

Contributions

E. de Miguel: Grant/research support from Abbvie; A. Pecondón-Español: Grant/research support from Abbvie; M. Castaño-Sánchez: Grant/research support from Abbvie; A. Corrales: Grant/research support from Abbvie; R. Gutierrez-Polo: Grant/research support from Abbvie; M. Manuel Rodriguez-Gomez: Grant/research support from Abbvie; J. Ivorra: Grant/research support from Abbvie; J. L. Rivas: Employee of Abbvie.

Corresponding author

Correspondence to Eugenio de Miguel.

Appendix

Appendix

The ECO-DAI group consists of the following centers (participants):

Hospital de Mérida, Badajoz (Adela Gallego Flores); Hospital Infanta Leonor, Madrid (Maria Teresa Navío Marco, Laura Cebrián Méndez, María Ángeles Matías de la Mano); Hospital Virgen de la Salud, Toledo (Daniel Pielfort Garrido); Hospital Nuestra Señora de la Candelaria, Tenerife (Paula Ramos Núñez, Adán Martín Concepción); Hospital 12 de Octubre, Madrid (Laura González Hombrados); Hospital San Pedro de Alcántara, Cáceres (Fernando Gamero Ruiz, Esther del Rincón Padilla); Hospital La Princesa, Madrid (Esther de Vicente Rabaneda, Santos Castañeda Sanz, Silvia Pérez Esteban); Hospital Germans Trias i Pujol, Barcelona (Lourdes Mateo Soria, Susana Holgado Pérez); Hospital Vall d’ Hebron, Barcelona (Juan José de Agustín de Oro, Cayetano Alegre de Miguel); Hospital Joan XXIII, Tarragona (María José Poveda Elices, Sonia Castro Oreiro, Ramón Fontova Garrofé); Hospital Carlos Haya, Málaga (Francisco Gabriel Jiménez Núñez); Hospital Virgen del Rocío, Sevilla (Serafín Campos Sánchez, Jesús Quijado Carrera); Hospital de Jerez, Cádiz (Manuel Páez Camino Carrillo, Jose Luis de la Iglesia Salgado); Hospital Virgen de la Arrixaca, Murcia (Manuel Castaño Sanchez); Hospital Santa María del Rosell, Murcia (Juan Moreno Morales, Antonio Valcarcel Susarte, Vicente Cogolludo Campillo, Fernando José Rodríguez Martínez); Hospital Juan Canalejo, A Coruña (José Antonio Pinto Tasende, Eugenia González Díaz de Rábago, Jesús Carlos Fernández López); Hospital Clínico de Santiago, A Coruña (Antonio José Mera Varela); Hospital de Navarra, Navarra (Ricardo Gutierrez-Polo, Rosario Ibáñez Bosch); Hospital de Basurto, Vizcaya (Maria Luz García Vivar, Eva Galíndez Aguirregoika); Hospital de Galdakao, Vizcaya (Fernando Díaz Alcázar); Hospital de Sierrallana, Cantabria (Jaime Calvo Alen, Teresa Ruiz Jimeno); Complejo Hospitalario Ourense, Ourense (Manuel Rodríguez Gómez, Balbina González Álvarez); Hospital de León, León (Trinidad Pérez Sandoval, Manuel Martín Martínez, Alejandra López Robles, Carolina Álvarez Castro, Elvira Álvarez Diez); Hospital Son Llatzer, Illes Balears (Inmaculada Ros Vilamajo, Antonio Juan Mas, Mónica Ibáñez Barceló); Hospital del Mar, Barcelona (Maria Pilar Lisbona Pérez); Hospital General de Manresa, Barcelona (Roser Tuneu, Mario Saúl Gelman Alzen); Hospital Lozano Blesa, Zaragoza (Emilio Giner Serret); Hospital General de Valencia, Valencia (Cristina Campos Fernández); Hospital Mutua de Terrassa, Barcelona (Manuel Pujol Risquets); Hospital Miguel Servet, Zaragoza (Ángela Pecondon Español, Marta Medrano San Ildefonso, Chesús Beltrán Audera); Hospital Doctor Peset, Valencia (Juan Jose Alegre Sancho, José Ivorra-Cortés); Hospital La Paz, Madrid (Eugenio de Miguel Mendieta); Hospital de Móstoles, Madrid (Jacqueline Usón Jaeger); Hospital Ramón y Cajal, Madrid (Elia Brito Brito); Hospital Clínico de Madrid, Madrid (María Pilar Macarrón Pérez, Esther Toledano Correo); Hospital Central de Asturias, Asturias (Francisco Javier Ballina García, Mercedes Alperi López, Rubén Queiro Silva); Hospital Comarcal de Laredo, Cantabria (Alfonso Corrales Martínez, Rosa Expósito Molinero); Hospital Virgen de la Concha (Juan Pablo Valdazo de Diego, Ruth Lopez González, Olga Martinez González); Hospital Río Carrión, Palencia (Julio Medina Luezas, María Alvarez de Buergo); Hospital Virgen Macarena, Sevilla (Francisco Javier Toyos Sáenz de Miera, Maria Dolores Garcia Armario); Hospital Marina Baixa, Alicante (Jose Carlos Rosas Gómez de Salazar, José Miguel Senabre Gallego, Carlos Santos Ramírez); Hospital Sant Joan, Alicante (María Pilar Bernabéu González, Esteban J. Salas Heredia); Hospital Virgen de las Nieves, Granada (Miguel Ángel Ferrer González, Manuel Alejandro Guzmán Úbeda, Rafael Cáliz Cáliz, Alfonso González Utrilla); Hospital Clínico San Cecilio, Granada (Enrique Raya Álvarez, Juan Salvatierra Osorio, Ana Nieto González); Hospital de Ceuta, Ceuta (Noelia Vázquez Fuentes).

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de Miguel, E., Pecondón-Español, A., Castaño-Sánchez, M. et al. A reduced 12-joint ultrasound examination predicts lack of X-ray progression better than clinical remission criteria in patients with rheumatoid arthritis. Rheumatol Int 37, 1347–1356 (2017). https://doi.org/10.1007/s00296-017-3714-5

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