الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
RA disease remission is considered as the ultimate goal of recent treatment strategies. To define RA remission, indices based on clinical and laboratory biomarkers have been developed.
Clinical indices were proved to be lacking sensitivity to detect low levels of inflammation in many studies. Recently MSUS has been able to detect and quantify subclinical synovitis with more specificity and reliability, in patients classified as being in remission according to many clinical indices.
Our aim was to detect the persistence of Gray Scale and Power Doppler signals in rheumatoid arthritis patients in clinical remission or low disease activity, as assessed by DAS28-ESR and compared to the scored results by the US7 score.
For this purpose, we recruited 50 RA patients who fulfilled the ACR/EULAR 2010 criteria for diagnosis of RA to participate in this study. The patients were selected from those attending the Outpatient Clinic of Physical Medicine, Rheumatology and Rehabilitation Department and the Rheumatology and Immunology unit, Internal Medicine department, Faculty of Medicine, Alexandria University. The patients were selected as having reached remission or low disease activity (LDA) using the cut-off values of the DAS28-ESR score. Patients with osteoarthritis, HCV arthritis or any systemic disease with inflammatory arthropathies were excluded.
Demographic and clinical data including disease duration, duration of remission and drug history were collected, and DAS28-ESR was calculated for all patients. Laboratory investigations including CBC, ESR, CRP, ALT, AST, serum uric acid, PCR for HCV, and serum antibodies including RF and Anti-CCP, were all done to every patient. US7 score was calculated for all patients after GS and PD examination.
Out of 50 RA patients, 74 % were females and 26 % were males with an age mean of mean of 49.58 ± 9.14 years. The disease duration ranged from 1.5 to 17 years. The ESR ranged from 5-26 mm/hr. 14% of the patients were RF negative, while 86% were RF positive. Regarding the Anti-CCP, 58% of our patients showed positive test results versus 42% with negative tests. 66% of the patients were on csDMARDs, while 34% of the patients were on bDMARDs.
As assessed by DAS28-ESR score, 34 patients were in clinical remission (68%) and 16 patients in low disease activity (32%). 58% of our cohort had ultrasonographic activity- whether synovitis detected in GS or PD examination- while 42% showed ultrasonographic remission. Out of 34 patients in clinical remission, 38.2 % showed ultrasonographic activity while 61.8% were in true combined clinical and ultrasonographic remission.
PD signals of tenosynovitis was higher in females, reflecting a subclinical inflammatory process. No significant difference between patients in US remission and those in US activity regarding the csDMARDs or bDMARDs use. Anti-CCP levels showed highly significant difference between patients in true remission and those with subclinical activity.
In conclusion, subclinical synovitis is a frequent finding in the joints of RA patients in clinical remission or LDA, and occurs independently from the treatment used to achieve clinical remission. Female RA patients suffer from active subclinical tenosynovitis more than males. Anti-CCP levels of RA patients in remission with subclinical synovitis correlated with PD signals and tenosynovitis GS.