Ultrasonography predicts achievement of Boolean remission after DAS28-based clinical remission of rheumatoid arthritis

<p><i>Objectives.</i> To determine whether ultrasonography (US) predicts Boolean remission in rheumatoid arthritis (RA) patients who had achieved disease activity score in 28 joints (DAS28)-based remission criteria.</p> <p><i>Methods.</i> Thirty-one RA patients in DAS28-based clinical remission were recruited. US semiquantitatively determined Gray scale (GS) and power Doppler (PD) signal scores in the bilateral wrists and all metacarpophalangeals and proximal interphalangeals. Total GS score and total PD score were calculated as the sum of individual scores for each joint.</p> <p><i>Results.</i> Among 22 RA patients, who maintained DAS28 remission for 2 years, 16 met Boolean remission criteria at the end of study. Both total GS and total PD scores at baseline were significantly lower in Boolean remission group than non-remission group. There was no significant difference in other baseline parameters, including duration of disease, duration of remission, mTSS, and disease activity composite parameters between the two groups. Among the factors for Boolean remission criteria at 2 years, patient global assessment score was associated with total GS score at the entry, while swollen joint count was related to total PD score.</p> <p><i>Conclusions.</i> Null or low grade of GS and PD findings in US are associated with achieving Boolean remission. Thus, US is essential for assessment and prediction of “deeper remission” of RA.</p

The predictive prognostic factors for polymyositis/dermatomyositis-associated interstitial lung disease

Abstract Background Interstitial lung disease (ILD) is the principal cause of death in polymyositis/dermatomyositis (PM/DM). Here we investigated prognostic factors for death and serious infection in PM/DM-ILD using the multicenter database. Methods We retrospectively reviewed baseline demographic, clinical and laboratory findings, treatment regimens and outcomes in patients with PM/DM-ILD. The distribution of ILD lesions was evaluated in four divided lung zones of high-resolution computed tomography images. Results Of 116 patients with PM/DM-ILD, 14 died within 6 months from the diagnosis. As independent risk factors for early death, extended ILD lesions in upper lung fields (odds ratio (OR) 8.01, p = 0.016) and hypocapnia (OR 6.85, p = 0.038) were identified. Serious infection was found in 38 patients, including 11 patients who died of respiratory or multiple infections. The independent risk factors were high serum KL-6 (OR 3.68, p = 0.027), high initial dose of prednisolone (PSL) (OR 4.18, p = 0.013), and combination immunosuppressive therapies (OR 5.51, p < 0.001). Conclusion The present study shows the progression of ILD at baseline is the most critical for survival and that infection, especially respiratory infection, is an additive prognostic factor under the potent immunosuppressive treatment

On-demand ultrasonography assessment in the most symptomatic joint supports the 8-joint score system for management of rheumatoid arthritis patients

<p><i>Objectives</i>: To investigate whether on-demand ultrasonography (US) assessment alongside a routine examination is useful in the management of rheumatoid arthritis (RA).</p> <p><i>Methods</i>: US was performed in eight (bilateral MCP 2, 3, wrist and knee) joints as the routine in a cumulative total of 406 RA patients. The most symptomatic joint other than the routine joints was additionally scanned. Power Doppler (PD) and gray-scale images were scored semiquantitatively. Eight-joint scores were calculated as the sum of individual scores for the routine joints.</p> <p><i>Results</i>: The most symptomatic joint was found among the routine joints in 209 patients (Group A) and in other joints in 148 (Group B). The PD scores of the most symptomatic joint correlated well with the 8-joint scores in Group A (r_s = 0.66), but not in Group B (r_s = 0.33). The sensitivity and specificity of assessment of the most symptomatic joint for routine assessment positivity were high (84.0% and 100%, respectively) in Group A, but low (50.0% and 61.8%, respectively) in Group B. Additional examination detected synovitis in 38% of Group B with negative results in the routine.</p> <p><i>Conclusions</i>: On-demand US assessment in the most symptomatic joint, combined with the routine assessment, is useful for detecting RA synovitis.</p

¹⁸F-FDG and ¹⁸F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

<p><i>Objective.</i> To compare the findings in rheumatoid arthritis (RA)-affected joints between ¹⁸F-fluorodeoxyglucose (FDG) and ¹⁸F-fluoride (NaF) positron emission tomography (PET)/computed tomography (CT).</p> <p><i>Methods.</i> We enrolled twelve RA patients who started a new biologic agent (naïve 9 and switch 3). At entry, both hands were examined by ¹⁸F-FDG PET/CT, ¹⁸F-NaF PET/CT, and X-ray. Intensity of PET signals was determined by standardized uptake value max (SUVmax) in metacarpophalangeal (MCP), proximal interphalangeal (PIP), and ulnar, medial, and radial regions of the wrists. Hand X-rays were evaluated according to the Genant-modified Sharp score at baseline and 6 months.</p> <p><i>Results.</i> Both ¹⁸F-FDG and ¹⁸F-NaF accumulated in RA-affected joints. The SUVmax of ¹⁸F-FDG correlated with that of ¹⁸F-NaF in individual joints (<i>r</i> = 0.65), though detail distribution was different between two tracers. ¹⁸F-NaF and ¹⁸F-FDG signals were mainly located in the bone and the surrounding soft tissues, respectively. The sum of SUVmax of ¹⁸F-NaF correlated with disease activity score in 28 joint (DAS28), modified health assessment questionnaire (MHAQ), and radiographic progression. ¹⁸F-FDG and ¹⁸F-NaF signals were associated with the presence of erosions, particularly progressive ones.</p> <p><i>Conclusion.</i> Our data show that both ¹⁸F-FDG and ¹⁸F-NaF PET signals were associated with RA-affected joints, especially those with ongoing erosive changes.</p