Clinical Remission Versus Imaging Remission in Rheumatoid Arthritis

by Lauren Taylor from In The Cloud Copy

Rheumatoid arthritis (RA) is an auto-immune condition that occurs when the body’s immune system mistakenly targets the joint linings causing inflammation, pain, and damage. RA affects the joints on both sides of the patient’s body including hands, knees, wrists, and more. The effect on both sides of the body sets RA apart from other arthritis types that do not present in this symmetrical fashion. RA can also affect the patient’s lungs, heart, eyes, skin, blood, and nerves.

Symptoms of RA typically include swelling, stiffness, and pain in the affected joints, as well as loss of function and deformities in the joints. Symptoms are variable and can come and go, so it’s important to not ignore them if you are experiencing any such symptoms. Treatment for RA varies depending on severity of the condition and symptoms, but can include medications, dietary changes, and certain types of exercise.

Blood tests for RA may include a variety of tests, but most commonly, a rheumatoid factor (RF) test is conducted, checking for the rheumatoid factor protein. An anticitrullinated protein antibody test (anti-CCP) may also be conducted to look for a certain antibody associated with RA. People who have the anti-CCP have RA, but not every patient with RA tests positive for this antibody. An antinuclear antibody test may also be done, which tests to see if the body is producing antibodies. A few other tests, such as erythrocyte sedimentation rate (ESR) and c-reactive protein, may also be performed to assess any inflammation in the body.

Clinical Remission Versus Imaging Remission

RA patients are often assessed frequently to see if they have achieved clinical remission, but may not have achieved imaging remission, a new study finds. Clinical remission exists when patient’s signs and symptoms have reduced greatly. The study analyzed almost 100 patients with RA who, based on a Disease Activity Score for Rheumatoid Arthritis with ESR (DAS28-ESR), had achieved clinical remission. Clinicians then conducted an ultrasound evaluation on 2 tendons and more than 15 joints for all of the patients determined to be in clinical remission.

The patients, who had all been in clinical remission for greater than 6 months, also were RF positive (80.4% of patients) and anti-CCP positive (92.1% of patients). 20.6% of the patients were having their disease managed with biologics, a common class of medication used in RA.

Just over half (51.5%) of the patients who achieved clinical remission also saw remission in imaging. The remainder of the population, just under half, had a positive Power Doppler (PD) ultrasound. The radiocarpal joint was most often where PD was detected in these patients.

Interestingly, patients who achieved both clinical and imaging remission received lower clinical disease activity scores as well as lower evaluator global assessment scores. Those who reached clinical but not imaging remission had a higher chance of having a greater active joint count and were also more likely to have used NSAIDs.

Overall, this study shows the necessity of both imaging and looking at the clinical aspects. While a patient may clinically look and feel well, that does not necessarily mean that treatment should be ceased as joint damage and inflammation may still be occurring.

Find the original story here.

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