Trial reportRheumatology (Oxford, England)2025
Baseline synovitis-tenosynovitis is associated with remission in early rheumatoid arthritis, but discordance with disease activity is a changeable state.
Trial report in Rheumatology (Oxford, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe objectives of this study were to investigate the association between baseline joint-complex inflammation [power Doppler-detected joint synovitis (PDUS) and/or tenosynovitis (PDTS)] and remission in treatment-naïve, new-onset RA patients and to evaluate concordance and discordance states between clinical disease activity and power Doppler US and transition between these states longitudinally.
methodsAt baseline, treatment-naïve early RA patients from a randomized controlled trial were categorized according to dominant hand PDUS and/or PDTS presence into four groups (PDUS+PDTS+, PDUS+PDTS-, PDUS-PDTS+, PDUS-PDTS-). Longitudinally, patients were grouped based on both clinical DAS and PDUS presence into: DAS+PDUS+ (DAS28-ESR > 2.6, PDUS > 0), DAS+PDUS- (DAS28-ESR > 2.6, PDUS = 0), DAS-PDUS+ (DAS28ESR ≤ 2.6, PDUS > 0) and DAS-PDUS- (DAS28ESR ≤ 2.6, PDUS = 0). Bayesian logistic regression analysis was applied.
resultsBaseline PDUS+PDTS+ was associated with week 24 remission (posterior estimate = 1.41, credible interval = 0.16-2.65). At baseline diagnosis, 68% were DAS+PDUS+ and 32% DAS+PDUS-. Early transition from DAS+PDUS+ to DAS+PDUS- (32% at week 12) occurred. Overall proportions with DAS+PDUS- remained unchanged (43% at week 24); however, individual membership of this group changed over time, with only 41% at baseline remaining DAS+PDUS- through to week 48.
conclusionIn new-onset RA, baseline joint-complex power Doppler US associates with week 24 remission. DAS+PDUS- emerges early but, like DAS+PDUS+ and DAS-PDUS-, is a dynamic state, indicating opportunity for therapeutic targeting. Understanding the basis for these states can aid stratification and personalized treatment strategies.
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