Abstract
Ultrasonographic remission in addition to clinical remission is probably becoming a new target in the treatment of rheumatoid arthritis. The current study aimed to investigate the risk factors of flare in RA patients who achieved both clinical and ultrasonographic remission. RA patients fulfilled both clinical remission and ultrasonographic remissions were retrospectively enrolled in this study. Baseline clinical, laboratory, and ultrasonographic data were collected. Durations of clinical remission before enrollment and medication strategy during follow-up were recorded. Differences between the flare and the non-flare group were analyzed. Risk factors of flare were assessed with univariate and multivariate Cox proportional hazards models. One hundred and twenty-one RA patients were included. Forty-eight patients relapsed during a median follow-up period of 12.3 months. The flare group had higher percentage of females, shorter duration of clinical remission before enrollment, higher baseline ESR and DAS28 (ESR), and lower baseline gray scale score. Univariate Cox regression revealed female, short duration of remission, high DAS28 (ESR), and failure to achieve 2010 ACR/EULAR remission criteria were risk factors of flare. Furthermore, multivariate analysis showed short duration of remission was the only independent risk factor of flare (HR 0.93, 95% CI 0.88–0.98, P = 0.007). One more month in duration of remission led to a reduction in flare of 7.3%. Short duration of remission at baseline could be an independent risk factor of flare in RA patients who achieved both clinical and ultrasonographic remission, which implicates the significance of sustained remission in the prognosis of RA patients.
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Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G et al (2010) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69:631–637
Zufferey P, Moller B, Brulhart L, Tamborrini G, Scherer A, Finckh A et al (2014) Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the DAS28 and/or the new ACR/EULAR RA remission definitions: results of an observational cohort study. Joint Bone Spine 81:426–432
Anandarajah A, Thiele R, Giampoli E, Monu J, Seo GS, Feng C et al (2014) Patients with rheumatoid arthritis in clinical remission manifest persistent joint inflammation on histology and imaging studies. J Rheumatol 41:2153–2160
Foltz V, Gandjbakhch F, Etchepare F, Rosenberg C, Tanguy ML, Rozenberg S et al (2012) Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity. Arthritis Rheum 64:67–76
Scire CA, Montecucco C, Codullo V, Epis O, Todoerti M, Caporali R (2009) Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology (Oxford) 48:1092–1097
Saleem B, Brown AK, Quinn M, Karim Z, Hensor EM, Conaghan P 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
Ostergaard M, Moller-Bisgaard S (2014) Rheumatoid arthritis: is imaging needed to define remission in rheumatoid arthritis? Nat Rev Rheumatol 10:326–328
Wakefield RJ, D'Agostino MA, Naredo E, Buch MH, Iagnocco A, Terslev L et al (2012) After treat-to-target: can a targeted ultrasound initiative improve RA outcomes? Ann Rheum Dis 71:799–803
Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487
Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M (2003) Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 48:955–962
Geng Y, Han J, Deng X, Zhang Z (2016) Deep clinical remission—an optimised target in the management of rheumatoid arthritis? Experience from an ultrasonography study. Clin Exp Rheumatol 34:581–586
Jayakumar K, Norton S, Dixey J, James D, Gough A, Williams P et al (2012) Sustained clinical remission in rheumatoid arthritis: prevalence and prognostic factors in an inception cohort of patients treated with conventional DMARDS. Rheumatology (Oxford) 51:169–175
Kuriya B, Xiong J, Boire G, Haraoui B, Hitchon C, Pope J et al (2014) Earlier time to remission predicts sustained clinical remission in early rheumatoid arthritis—results from the Canadian Early Arthritis Cohort (CATCH). J Rheumatol 41:2161–2166
Jawaheer D, Messing S, Reed G, Ranganath VK, Kremer JM, Louie JS et al (2012) Significance of sex in achieving sustained remission in the consortium of rheumatology researchers of North America cohort of rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 64:1811–1818
Ramirez Garcia J, Ruiz-Esquide V, Celis R, Cuervo A, Cabrera S, Inciarte-Mundo J et al (2014) Sonographic and clinical characterization of a prospective cohort of patients with rheumatoid arthritis in clinical remission. Preliminary results Ann Rheum Dis 73
Iwamoto T, Ikeda K, Hosokawa J, Yamagata M, Tanaka S, Norimoto A et al (2014) Prediction of relapse after discontinuation of biologic agents by ultrasonographic assessment in patients with rheumatoid arthritis in clinical remission: high predictive values of total gray-scale and power Doppler scores that represent residual synovial inflammation before discontinuation. Arthritis Care Res (Hoboken) 66:1576–1581
Haschka J, Englbrecht M, Hueber AJ, Manger B, Kleyer A, Reiser M et al (2015) Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study. Ann Rheum Dis
Saleem B, Keen H, Goeb V, Parmar R, Nizam S, Hensor EM et al (2010) Patients with RA in remission on TNF blockers: when and in whom can TNF blocker therapy be stopped? Ann Rheum Dis 69:1636–1642
Tokai N, Ogasawara M, Gorai M, Matsuki Y, Yamada Y, Murayama G et al (2014) Predictive value of bone destruction and duration of clinical remission for subclinical synovitis in rheumatoid arthritis patients. Mod Rheumatol:1–6
Harman H, Tekeoglu I, Kaban N, Harman S (2015) Factors influencing ultrasonographic remission in patients with rheumatoid arthritis. Rheumatol Int 35:485–491
Aletaha D, Funovits J, Breedveld FC, Sharp J, Segurado O, Smolen JS (2009) Rheumatoid arthritis joint progression in sustained remission is determined by disease activity levels preceding the period of radiographic assessment. Arthritis Rheum 60:1242–1249
Balsa A, Del Amo J, Blanco F, Caliz R, Silva L, Sanmarti R et al (2010) Prediction of functional impairment and remission in rheumatoid arthritis patients by biochemical variables and genetic polymorphisms. Rheumatology (Oxford) 49:458–466
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The authors wish to thank Sainan Zhu for the help with the statistical analysis.
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Han, J., Geng, Y., Deng, X. et al. Risk factors of flare in rheumatoid arthritis patients with both clinical and ultrasonographic remission: a retrospective study from China. Clin Rheumatol 36, 1721–1727 (2017). https://doi.org/10.1007/s10067-017-3736-0
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DOI: https://doi.org/10.1007/s10067-017-3736-0