What Causes Joint Pain in Rheumatoid Arthritis Patients with Clinical Remission and Low Disease Activity according to DAS28?

Ultrasound and DAS-28

Abstract

Objective: This article aims to evaluate synovial activity in patients with rheumatoid arthritis (RA) who were in remission or had low disease activity according to the DAS-28 (Disease activity scale-28) but complained of joint pain.

Material and Methods: We    retrospectively    reviewed    records  and  admission  files  of  the  patients who  were  diagnosed  as  RA according to the criteria of the American Rheumatism Association between January 2016 and January 2018. The modified health assessment questionnaire (m-HAQ) and ultrasonographic evaluation of patients were recorded. Patients were compared in terms of demographic and disease characteristics according to the presence of synovitis detected with ultrasongraphy. In addition, correlations were evaluated between the presence of synovitis and demographic and disease characteristics.

Results: This trial included 53 patients with the diagnosis of RA who were in remission or had low disease activity (DAS-28 <3.2) for at least 6 months and had pain symptoms in at least one joint. Synovitis was detected on US in 23 (43.4%) patients, in these patients, tenderness joint count (TJC) (p =0.03) and m-HAQ (p =0.019) were significantly higher. The presence of synovitis was associated with an increase in TJC (r: 0.518, p=0.001) and a deterioration in general health(r: 0.318, p=0.025). This relationship was shown to continue in the multivariate regression analysis

Conclusion: Even if patients show clinical remission or low disease activity, ultrasonographic evaluation should be performed in the presence of joint complaints. The use of US will continue to play an important role in the management of patients with RA, including in the assessment of disease activity when the disease activity status is not clinically apparent.