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

Shukla, RR.; Wakefield, RJ.; Ho, P.; Tan, AL.; Emery, P.; Plant, D.; Buch, MH.

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

All Authors

Shukla, RR.

Wakefield, RJ.

Ho, P.

Tan, AL.

Emery, P.

Plant, D.

Buch, MH.

LTHT Author

Wakefield, Richard
Tan, Ai Lyn
Emery, Paul

LTHT Department

Rheumatology
NIHR Leeds Biomedical Research Centre

Publication Date

2025

Item Type

Journal Article
Randomised Controlled Trial

Abstract

OBJECTIVES: The 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-naive, 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. METHODS: At baseline, treatment-naive 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. 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. CONCLUSION: In 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.