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Rigshospitalet - a part of Copenhagen University Hospital
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Rheumatoid arthritis patients with predominantly tender joints rarely achieve clinical remission despite being in ultrasound remission

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DOI

  1. OMERACT definition and reliability assessment of chronic ultrasound lesions of the axillary artery in giant cell arteritis

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Seasonal variation in biopsy-proven giant cell arteritis in Eastern Denmark from 1990-2018

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. EULAR recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs)

    Research output: Contribution to journalJournal articleResearchpeer-review

  • Hilde Berner Hammer
  • Inger Marie Jensen Hansen
  • Pentti Järvinen
  • Marjatta Leirisalo-Repo
  • Michael Ziegelasch
  • Birte Agular
  • Lene Terslev
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Objectives: Given that subjective variables might reduce remission by composite DAS (CDAS), the main objectives were to explore whether RA patients with mainly tender vs mainly swollen joints had differences in patient-reported outcome measures (PROMs), clinical or US assessments or in achieving remission defined by CDAS or US.

Methods: In a Nordic multicentre study, RA patients initiating tocilizumab were assessed by PROMs, clinical, laboratory and US assessments (36 joints and 4 tendons) at baseline, 4, 12 and 24 weeks. Remission was defined according to clinical disease activity index (CDAI)/Boolean or no Doppler activity present. Tender-swollen joint differences (TSJDs) were calculated. Statistics exploring changes over time/differences between groups included Wilcoxon, Mann-Whitney, Kruskal-Wallis and Spearman tests.

Results: One hundred and ten patients were included [mean (s.d.) age 55.6 (12.1) years, RA duration 8.7 (9.5) years]. All PROMs, clinical, laboratory and US scores decreased during follow-up (P < 0.001). During follow-up, tender joint counts were correlated primarily with PROMs [r = 0.24-0.56 (P < 0.05-0.001)] and swollen joint counts with US synovitis scores [r = 0.33-0.72 (P < 0.05-0.001)]. At 24 weeks, patients with TSJD > 0 had higher PROMs and CDAI (P < 0.05-0.001) but lower US synovitis scores (P < 0.05). Remission by CDAI/Boolean was seen in 26-34% and by Doppler 53%, but only 2-3% of patients with TSJD > 0 achieved CDAI/Boolean remission.

Conclusion: Patients with more tender than swollen joints scored higher on subjective assessments but had less US synovitis. They seldom achieved CDAS remission despite many being in Doppler remission. If patients with predominantly tender joints do not reach CDAS remission, objective assessments of inflammation should be performed.

Trial registration: ClinicalTrials.gov, https://clinicaltrials.gov/, NCT02046616.

Original languageEnglish
JournalRheumatology Advances in Practice
Volume5
Issue number2
Pages (from-to)rkab030
ISSN2514-1775
DOIs
Publication statusPublished - 2021

    Research areas

  • rheumatoid arthritis, biological treatment, ultrasound, patient-reported outcomes

ID: 66419415