Ultrasound-detected subclinical inflammation was better reflected by the disease activity score (DAS-28) in patients with suspicion of inflammatory arthritis compared to established rheumatoid arthritis |
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Authors: | Coziana Ciurtin Karol Wyszynski Robert Clarke Maria Mouyis Jessica Manson Giampiero Marra |
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Institution: | 1.Department of Rheumatology,University College London Hospitals NHS Trust,London,UK;2.Department of Statistics,University College London,London,UK;3.Medical School,University College London,London,UK;4.Department of Rheumatology,Northwick Park Hospital,Harrow,UK |
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Abstract: | Limited data are available about the ultrasound (US)-detected inflammatory features in patients with suspicion of inflammatory arthritis (S-IA) vs. established rheumatoid arthritis (RA). Our study aimed to assess if the presence of power Doppler (PD) can be predicted by a combination of clinical, laboratory and US parameters. We conducted a real-life, retrospective cohort study comparing clinical, laboratory and US parameters of 108 patients with established RA and 93 patients with S-IA. We propose a PD signal prediction model based on a beta-binomial distribution for PD variable using a mix of outcome measures. Patients with RA in clinical remission had significantly more active inflammation and erosions on US when compared with patients with S-IA with similar disease scores (p?=?0.03 and p?=?0.01, respectively); however, RA patients with different disease activity score (DAS-28) scores had similar PD scores (p?=?0.058). The PD scores did not correlate with erosions (p?=?0.38) or DAS-28 scores (p?=?0.28) in RA patients, but they correlated with high disease activity in S-IA patients (p?=?0.048). Subclinical inflammation is more common in patients with RA in clinical remission or with low disease activity than in patients with S-IA; therefore, US was more useful in assessing for true remission in RA rather than diagnosing IA in patients with low disease activity scores. This is the first study to propose a PD prediction model integrating several outcome measures in the two different groups of patients. Further research into validating this model can minimise the risk of underdiagnosing subclinical inflammation. |
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