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Does tenosynovitis of the hand detected by B-mode ultrasound predict loss of clinical remission in rheumatoid arthritis? Results from a real-life cohort

Raphael Micheroli
Raphael Micheroli
, 
Almut Scherer
Almut Scherer
, 
Kristina Bürki
Kristina Bürki
, 
Pascal Zufferey
Pascal Zufferey
, 
Michael J. Nissen
Michael J. Nissen
, 
Laure Brulhart
Laure Brulhart
, 
Burkhard Möller
Burkhard Möller
, 
Hans-Rudolf Ziswiler
Hans-Rudolf Ziswiler
, 
Adrian Ciurea
Adrian Ciurea
 and 
Giorgio Tamborrini
Giorgio Tamborrini
   | Feb 08, 2022
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Article Category: Research paper
Published Online: Feb 08, 2022
Page range: 21 - 27
Received: Aug 22, 2021
Accepted: Nov 26, 2021
DOI: https://doi.org/10.15557/JoU.2022.0004
Keywords
© 2022 Raphael Micheroli, Almut Scherer, Kristina Bürki, Pascal Zufferey, Michael J. Nissen, Laure Brulhart, Burkhard Möller, Hans-Rudolf Ziswiler, Adrian Ciurea, Giorgio Tamborrini, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Examples of grading of tenosynovitis (TS) from 0–3 in B-Mode. Grade 0 – no TS; grade 1 – minimal TS; grade 2 – moderate TS; grade 3 – severe TS. fcr – flexor carpi radialis; arrowhead – synovial thickening, asterisks – anechoic effusion; star – anisotropy of the fcr tendon at the level of the osteofibrous canal
Examples of grading of tenosynovitis (TS) from 0–3 in B-Mode. Grade 0 – no TS; grade 1 – minimal TS; grade 2 – moderate TS; grade 3 – severe TS. fcr – flexor carpi radialis; arrowhead – synovial thickening, asterisks – anechoic effusion; star – anisotropy of the fcr tendon at the level of the osteofibrous canal

Fig. 2

Multiple adjusted hazard ratios (HR) for time to loss of remission comparing patients with versus without ultrasound-detected TS across different observed time periods and across all and early remission phases using left and right imputation. Progression events after the respective indicated observation time were censored. The numbers on the right of each panel are the HR with 95% confidence interval (CI) in brackets and below the number of occurred events
Multiple adjusted hazard ratios (HR) for time to loss of remission comparing patients with versus without ultrasound-detected TS across different observed time periods and across all and early remission phases using left and right imputation. Progression events after the respective indicated observation time were censored. The numbers on the right of each panel are the HR with 95% confidence interval (CI) in brackets and below the number of occurred events

Baseline characteristics at first ultrasound in remission in patients with ultrasound-detected tenosynovitis (USTS+) and those without (USTS–)

VariableNTenosynovitis
All (n = 402)Negative (n = 362)Positive (n = 40)P-value
Age in yrs, mean (SD)40254 (13.5)53.8 (13.6)56 (11.8)0.44
Male, n (%)402110 (27)99 (27)11 (28)1.00
Disease duration in yrs at baseline, median (IQR)4024.8 (2–10.4)4.9 (2.1–10.6)4.4 (1.7–7.6)0.21
Anti-CCP, n (%)381277 (73)252 (73)25 (68)0.44
RF, n (%)395275 (70)243 (68)32 (80)0.15
Synovitis score, mean (SD)
B-mode score (units/22)3977.4 (6.2)7.2 (6.3)9 (5.4)0.02
power-Doppler score (units/22)3731.2 (2.2)1 (2)2.3 (3.5)0.06
ESR (mm/h), mean (SD)3768.4 (8.1)8.5 (8.3)7.7 (6.1)0.69
CRP (mg/l), mean (SD)3913 (6)3 (6.2)2.9 (3.9)0.24
SJC28, median (IQR)4020 (0–1)0 (0–1)1 (0–2.2)0.00
TJC28, median (IQR)4020 (0–0)0 (0–0)0 (0–1)0.09
DAS28 at baseline, mean (SD)4021.8 (0.5)1.8 (0.5)2 (0.5)0.00
Physician global, mean (SD)3791.3 (1.1)1.1 (1.1)2.2 (1.3)0.00
Radai, mean (SD)2272 (2)1.9 (2)2.4 (1.9)0.15
SDAI, mean (SD)2094.5 (4)4.3 (3.8)7.7 (4.4)0.00
CDAI, mean (SD)2144.2 (4)4 (3.8)7.4 (4.3)0.00
HAQ, median (IQR)2370.1 (0–0.6)0.1 (0–0.5)0.2 (0–0.9)0.24
Smoking status3620.86
never smoker, n (%)172 (48)156 (47)16 (52)
former smoker, n (%)104 (29,)95 (29)9 (29)
current smoker, n (%)86 (24)80 (24)6 (19)
Body mass index, mean (SD)34025.1 (4.9)25.1 (4.8)24.9 (5.4)0.42
Treatment4020.57
bDMARD treatment at baseline, n (%)242 (60)220 (61)22 (55)
csDMARD treatment at baseline, n (%)132 (33)118 (33)14 (35)
no DMARD treatment at baseline, n (%)28 (7)24 (7)4 (10)
Yrs in rem. before (left imput., mode 2), median (IQR)4021 (0.4–2.1)1 (0.5–2.1)0.6 (0.3–1.2)0.04
Yrs in rem. before (right imput., mode 1), median (IQR)4020 (0–0.5)0 (0–0.6)0 (0–0)0.05
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