Ultrasound-detected bone erosion is a relapse risk factor after discontinuation of biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis whose ultrasound power Doppler synovitis activity and clinical disease activity are well controlled

Arthritis Research & Therapy

Toshiyuki Aramaki¹  Shin-ya Kawashiri²  Takahiro Maeda²  Mami Tamai³  Hideki Nakamura³  Masataka Umeda³  Atsushi Kawakami³  Ayako Nishino³  Naoki Iwamoto³  Tomoki Origuchi³  Toshimasa Shimizu³  Shoichi Fukui³  Tomohiro Koga³  Kunihiro Ichinose³  Keita Fujikawa⁴  Akinari Mizokami⁴  Akitomo Okada⁵  Yukitaka Ueki⁵  Takahisa Suzuki⁵  Kiyoshi Aoyagi⁶ 

[1] Center for Rheumatic disease, Sasebo Chuo Hospital;Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences;Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences;Department of Internal Medicine, Isahaya General Hospital;Department of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital;Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences;

关键词: Rheumatoid arthritis;    RA;    Ultrasound;    Biologic disease-modifying antirheumatic drug;    bDMARD;    Remission;   

DOI  :  10.1186/s13075-017-1320-2

来源: DOAJ

【 摘 要 】

Abstract Background In the present study, we explored the risk factors for relapse after discontinuation of biologic disease-modifying antirheumatic drug (bDMARD) therapy in patients with rheumatoid arthritis (RA) whose ultrasound power Doppler (PD) synovitis activity and clinical disease activity were well controlled. Methods In this observational study in clinical practice, the inclusion criteria were based on ultrasound disease activity and clinical disease activity, set as low or remission (Disease Activity Score in 28 joints based on erythrocyte sedimentation rate <3.2). Ultrasound was performed in 22 joints of bilateral hands at discontinuation for evaluating synovitis severity and presence of bone erosion. Patients with a maximum PD score ≤1 in each joint were enrolled. Forty patients with RA were consecutively recruited (November 2010–March 2015) and discontinued bDMARD therapy. Variables at the initiation and discontinuation of bDMARD therapy that were predictive of relapse during the 12 months after discontinuation were assessed. Results The median patient age was 54.5 years, and the median disease duration was 3.5 years. Nineteen (47.5%) patients relapsed during the 12 months after the discontinuation of bDMARD therapy. Logistic regression analysis revealed that only the presence of bone erosion detected by ultrasound at discontinuation was predictive of relapse (OR 8.35, 95% CI 1.78–53.2, p = 0.006). No clinical characteristics or serologic biomarkers were significantly different between the relapse and nonrelapse patients. The ultrasound synovitis scores did not differ significantly between the groups. Conclusions Our findings are the first evidence that ultrasound bone erosion may be a relapse risk factor after the discontinuation of bDMARD therapy in patients with RA whose PD synovitis activity and clinical disease activity are well controlled.

【 授权许可】

Unknown