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

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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-naïve, 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-naïve 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.

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