PDUS-detected synovitis predicts short-term flares in PsA patients in remission
Power Doppler ultrasound (PDUS)-detected synovitis strongly predicts short-term flares among patients with psoriatic arthritis (PsA) in clinical remission, reports a new study.
To assess PDUS features at joint level and to assess its value for predicting short-term flares, the investigators followed consecutive patients with PsA in clinical remission according to the attending rheumatologist and who fulfilled minimal disease activity criteria and/or 28-joint Disease Activity Score in remission criteria for 6 months. All patients underwent PDUS examination of 18 joints.
Disease flare referred to any increase in disease activity generating the need for any of the following changes in therapy with disease-modifying antirheumatic drugs (DMARD) by the attending rheumatologist: dose increase, switch or addition of a different DMARD, and/or switch or addition of biological therapies.
There were 54 patients with PsA in clinical remission, of which 15 (27.8 percent) had a flare within the next 6 months. A total of 20 patients had at least one joint with PDUS synovitis at baseline; of these, 13 (65 percent) had a disease flare during the follow-up period compared with only two of the 34 patients (5.9 percent) without baseline PDUS synovitis (relative risk, 11; 95 percent CI, 2.8 to 44; p<0.001).
Logistic regression analysis revealed that the only variables associated with short-term flares were baseline PDUS synovitis and the use of nonbiologic DMARD.
According to researchers, “PDUS has been shown to detect subclinical synovitis in PsA, but its value is not yet fully understood.”