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Are rheumatoid arthritis patients who are told that they meet criteria for clinical remission getting the full story?
“Despite clinical remission, histology and imaging studies documented a persistently active disease state that may benefit from more aggressive therapy.” That’s the conclusion of Dr. Allen P. Anandarajah, an immunology and rheumatology researcher at the University of Rochester (N.Y.), and his colleagues, who documented persistently active rheumatoid arthritis (RA) in more than three-quarters of 14 patients in clinical remission (J. Rheumatol. 2014 [doi:10.3899/jrheum.140411]).
The study is the latest addition to the literature demonstrating that the sensitivity of current criteria for measuring diminished disease activity in persons with RA is too low (Arthritis Rheum. 2005;52:3381-90; Ann. Rheum. Dis. 2010;69:631-7; and Semin. Arthritis Rheum. 2005;35:185-96).
“The current outcome measures fall short,” Dr. Anandarajah and his coauthors wrote. “A major gap to be addressed is accurate and reliable methods to detect active synovitis in patients deemed to be in clinical remission.”
Dr. Anandarajah and his colleagues retrospectively analyzed 15 synovial specimens from 14 patients who met 1996 revised American College of Rheumatology criteria for clinical remission from RA who had undergone orthopedic surgery. The investigators also scored histologic specimens for hyperplasia of synovial lining and stroma, as well as inflammation, lymphoid follicles, and vascularity.
The disease-modifying antirheumatic drug regimens for the patients included four on anti–tumor necrosis factor therapy (two monotherapy and two with methotrexate); four were receiving methotrexate alone; four were on combined methotrexate and hydroxychloroquine therapy; one on methotrexate and low-dose prednisone; and one on hydroxychloroquine, sulfasalazine, and low-dose prednisone.
On histology, the investigators rated disease activity as severe in four specimens, moderate in six, mild in three, and minimal in two. Three of the four specimens with minimal and mild histology were from those receiving anti-tumor necrosis factor therapy.
The investigators detected synovitis on ultrasound grayscale in 8 of 10 joints in nine patients and power Doppler signal in 6 of 10 joints. Synovitis and bone marrow edema was shown on MRI scans in six of seven patients. The authors also calculated positive, although not significant, correlations between synovitis scores on ultrasonography and histology.
Although the study was limited in that the evaluations were scored retrospectively, and the images had been obtained for reasons other than future scoring of synovitis, the authors wrote that their findings were evidence that additional prospective studies could help determine whether incorporating histologic and imaging studies into remission criteria would be beneficial.
No disclosures were reported with the study.
On Twitter @whitneymcknight
Are rheumatoid arthritis patients who are told that they meet criteria for clinical remission getting the full story?
“Despite clinical remission, histology and imaging studies documented a persistently active disease state that may benefit from more aggressive therapy.” That’s the conclusion of Dr. Allen P. Anandarajah, an immunology and rheumatology researcher at the University of Rochester (N.Y.), and his colleagues, who documented persistently active rheumatoid arthritis (RA) in more than three-quarters of 14 patients in clinical remission (J. Rheumatol. 2014 [doi:10.3899/jrheum.140411]).
The study is the latest addition to the literature demonstrating that the sensitivity of current criteria for measuring diminished disease activity in persons with RA is too low (Arthritis Rheum. 2005;52:3381-90; Ann. Rheum. Dis. 2010;69:631-7; and Semin. Arthritis Rheum. 2005;35:185-96).
“The current outcome measures fall short,” Dr. Anandarajah and his coauthors wrote. “A major gap to be addressed is accurate and reliable methods to detect active synovitis in patients deemed to be in clinical remission.”
Dr. Anandarajah and his colleagues retrospectively analyzed 15 synovial specimens from 14 patients who met 1996 revised American College of Rheumatology criteria for clinical remission from RA who had undergone orthopedic surgery. The investigators also scored histologic specimens for hyperplasia of synovial lining and stroma, as well as inflammation, lymphoid follicles, and vascularity.
The disease-modifying antirheumatic drug regimens for the patients included four on anti–tumor necrosis factor therapy (two monotherapy and two with methotrexate); four were receiving methotrexate alone; four were on combined methotrexate and hydroxychloroquine therapy; one on methotrexate and low-dose prednisone; and one on hydroxychloroquine, sulfasalazine, and low-dose prednisone.
On histology, the investigators rated disease activity as severe in four specimens, moderate in six, mild in three, and minimal in two. Three of the four specimens with minimal and mild histology were from those receiving anti-tumor necrosis factor therapy.
The investigators detected synovitis on ultrasound grayscale in 8 of 10 joints in nine patients and power Doppler signal in 6 of 10 joints. Synovitis and bone marrow edema was shown on MRI scans in six of seven patients. The authors also calculated positive, although not significant, correlations between synovitis scores on ultrasonography and histology.
Although the study was limited in that the evaluations were scored retrospectively, and the images had been obtained for reasons other than future scoring of synovitis, the authors wrote that their findings were evidence that additional prospective studies could help determine whether incorporating histologic and imaging studies into remission criteria would be beneficial.
No disclosures were reported with the study.
On Twitter @whitneymcknight
Are rheumatoid arthritis patients who are told that they meet criteria for clinical remission getting the full story?
“Despite clinical remission, histology and imaging studies documented a persistently active disease state that may benefit from more aggressive therapy.” That’s the conclusion of Dr. Allen P. Anandarajah, an immunology and rheumatology researcher at the University of Rochester (N.Y.), and his colleagues, who documented persistently active rheumatoid arthritis (RA) in more than three-quarters of 14 patients in clinical remission (J. Rheumatol. 2014 [doi:10.3899/jrheum.140411]).
The study is the latest addition to the literature demonstrating that the sensitivity of current criteria for measuring diminished disease activity in persons with RA is too low (Arthritis Rheum. 2005;52:3381-90; Ann. Rheum. Dis. 2010;69:631-7; and Semin. Arthritis Rheum. 2005;35:185-96).
“The current outcome measures fall short,” Dr. Anandarajah and his coauthors wrote. “A major gap to be addressed is accurate and reliable methods to detect active synovitis in patients deemed to be in clinical remission.”
Dr. Anandarajah and his colleagues retrospectively analyzed 15 synovial specimens from 14 patients who met 1996 revised American College of Rheumatology criteria for clinical remission from RA who had undergone orthopedic surgery. The investigators also scored histologic specimens for hyperplasia of synovial lining and stroma, as well as inflammation, lymphoid follicles, and vascularity.
The disease-modifying antirheumatic drug regimens for the patients included four on anti–tumor necrosis factor therapy (two monotherapy and two with methotrexate); four were receiving methotrexate alone; four were on combined methotrexate and hydroxychloroquine therapy; one on methotrexate and low-dose prednisone; and one on hydroxychloroquine, sulfasalazine, and low-dose prednisone.
On histology, the investigators rated disease activity as severe in four specimens, moderate in six, mild in three, and minimal in two. Three of the four specimens with minimal and mild histology were from those receiving anti-tumor necrosis factor therapy.
The investigators detected synovitis on ultrasound grayscale in 8 of 10 joints in nine patients and power Doppler signal in 6 of 10 joints. Synovitis and bone marrow edema was shown on MRI scans in six of seven patients. The authors also calculated positive, although not significant, correlations between synovitis scores on ultrasonography and histology.
Although the study was limited in that the evaluations were scored retrospectively, and the images had been obtained for reasons other than future scoring of synovitis, the authors wrote that their findings were evidence that additional prospective studies could help determine whether incorporating histologic and imaging studies into remission criteria would be beneficial.
No disclosures were reported with the study.
On Twitter @whitneymcknight
FROM JOURNAL OF RHEUMATOLOGY
Key clinical point: Clinical remission of rheumatoid arthritis may be more conclusive with imaging.
Major finding: Synovitis was seen on ultrasound grayscale in 8 of 10 joints in nine patients and power Doppler signal in 6 of 10 joints. Synovitis and bone marrow edema was shown on MRI scans in six of seven patients.
Data source: Analysis of 15 synovial specimens from 14 patients in clinical remission from rheumatoid arthritis.
Disclosures: No disclosures were reported.