The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound
Identifieur interne : 000049 ( France/Analysis ); précédent : 000048; suivant : 000050The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound
Auteurs : Maxime Dougados [France] ; Valérie Devauchelle-Pensec [France] ; Jean François Ferlet [France] ; Sandrine Jousse-Joulin [France] ; Maria-Antonietta D'Agostino [France] ; Marina Backhaus [Allemagne] ; Jacques Bentin [Belgique] ; Gérard Chalès [France] ; Isabelle Chary-Valckenaere [France] ; Philip Conaghan [Royaume-Uni] ; Richard J. Wakefield [Royaume-Uni] ; Frédéric Etcheparre [France] ; Philippe Gaudin [France] ; Walter Grassi [Italie] ; Désirée Van Der Heijde [Pays-Bas] ; Xavier Mariette [France] ; Esperanza Naredo [Espagne] ; Marcin Szkudlarek [Danemark]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2013-05.
Abstract
Objectives To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA). Methods Patients with RA. Study design Prospective, 2-year follow-up. Data collected Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2. Analysis Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis. Results Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36–2.98) p<0.001 versus 1.61 (1.06–2.45) p=0.026 versus 1.75 (1.18–2.58) p=0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR=2.16 (1.16–4.02) p=0.015 and 3.50 (1.77–6.95) p<0.001 for US-GS and US-PD and 2.79 (1.35–5.76) p=0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression. Conclusions This study confirms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.
Url:
DOI: 10.1136/annrheumdis-2012-201469
Affiliations:
- Allemagne, Belgique, Danemark, Espagne, France, Italie, Pays-Bas, Royaume-Uni
- Angleterre, Berlin, Communauté de Madrid, Hollande-Méridionale, Région de Bruxelles-Capitale, Yorkshire-et-Humber
- Berlin, Boulogne-Billancourt, Brest, Bruxelles, Leeds, Leyde, Lyon, Madrid, Paris, Rennes
- Université de Leeds
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Methods Patients with RA. Study design Prospective, 2-year follow-up. Data collected Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2. Analysis Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis. Results Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36–2.98) p<0.001 versus 1.61 (1.06–2.45) p=0.026 versus 1.75 (1.18–2.58) p=0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR=2.16 (1.16–4.02) p=0.015 and 3.50 (1.77–6.95) p<0.001 for US-GS and US-PD and 2.79 (1.35–5.76) p=0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression. Conclusions This study confirms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Belgique</li><li>Danemark</li><li>Espagne</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Berlin</li><li>Communauté de Madrid</li><li>Hollande-Méridionale</li><li>Région de Bruxelles-Capitale</li><li>Yorkshire-et-Humber</li></region><settlement><li>Berlin</li><li>Boulogne-Billancourt</li><li>Brest</li><li>Bruxelles</li><li>Leeds</li><li>Leyde</li><li>Lyon</li><li>Madrid</li><li>Paris</li><li>Rennes</li></settlement><orgName><li>Université de Leeds</li></orgName></list><tree><country name="France"><noRegion><name sortKey="Dougados, Maxime" sort="Dougados, Maxime" uniqKey="Dougados M" first="Maxime" last="Dougados">Maxime Dougados</name></noRegion><name sortKey="Chales, Gerard" sort="Chales, Gerard" uniqKey="Chales G" first="Gérard" last="Chalès">Gérard Chalès</name><name sortKey="Chary Valckenaere, Isabelle" sort="Chary Valckenaere, Isabelle" uniqKey="Chary Valckenaere I" first="Isabelle" last="Chary-Valckenaere">Isabelle Chary-Valckenaere</name><name sortKey="D Agostino, Maria Antonietta" sort="D Agostino, Maria Antonietta" uniqKey="D Agostino M" first="Maria-Antonietta" last="D'Agostino">Maria-Antonietta D'Agostino</name><name sortKey="Devauchelle Pensec, Valerie" sort="Devauchelle Pensec, Valerie" uniqKey="Devauchelle Pensec V" first="Valérie" last="Devauchelle-Pensec">Valérie Devauchelle-Pensec</name><name sortKey="Etcheparre, Frederic" sort="Etcheparre, Frederic" uniqKey="Etcheparre F" first="Frédéric" last="Etcheparre">Frédéric Etcheparre</name><name sortKey="Ferlet, Jean Francois" sort="Ferlet, Jean Francois" uniqKey="Ferlet J" first="Jean François" last="Ferlet">Jean François Ferlet</name><name sortKey="Gaudin, Philippe" sort="Gaudin, Philippe" uniqKey="Gaudin P" first="Philippe" last="Gaudin">Philippe Gaudin</name><name sortKey="Jousse Joulin, Sandrine" sort="Jousse Joulin, Sandrine" uniqKey="Jousse Joulin S" first="Sandrine" last="Jousse-Joulin">Sandrine Jousse-Joulin</name><name sortKey="Mariette, Xavier" sort="Mariette, Xavier" uniqKey="Mariette X" first="Xavier" last="Mariette">Xavier Mariette</name></country><country name="Allemagne"><region name="Berlin"><name sortKey="Backhaus, Marina" sort="Backhaus, Marina" uniqKey="Backhaus M" first="Marina" last="Backhaus">Marina Backhaus</name></region></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Bentin, Jacques" sort="Bentin, Jacques" uniqKey="Bentin J" first="Jacques" last="Bentin">Jacques Bentin</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Conaghan, Philip" sort="Conaghan, Philip" uniqKey="Conaghan P" first="Philip" last="Conaghan">Philip Conaghan</name></region><name sortKey="Wakefield, Richard J" sort="Wakefield, Richard J" uniqKey="Wakefield R" first="Richard J" last="Wakefield">Richard J. 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