Baseline synovitis-tenosynovitis associates with remission in early rheumatoid arthritis but discordance with disease activity is a changeable state

Abstract

Objectives 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 rheumatoid arthritis (RA) patients and to evaluate concordance and discordance states between clinical disease activity and PD ultrasound and transition between these states longitudinally. Methods At baseline, treatment-naïve early RA patients from a randomised 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 disease activity state (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. Results Baseline 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. Conclusions In new-onset RA, baseline joint-complex PD 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 personalised treatment strategies.