JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v6i2.2525 jpsim.v6i2.2525 Original Research The Role of Ultrasound in Defining Remission in Rheumatoid Arthritis Afzal Masem Maqsood Muhammad Khan Fahad Aman Khan Imran Faiq Muhammad Rajpout Nauman Rafi naumanrafi@hotmail.com * Gulab Devi Hospital Lahore *Correspondence: Nauman Rafi Rajpout (naumanrafi@hotmail.com) 05 06 2025 2025 6 2 128 135 11 12 2024 20 01 2025 26 04 2025 Copyright © 2025 The Author(s) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

This review evaluates the role of Ultrasound in defining Rheumatoid arthritis (RA) remission, compares its sensitivity with traditional scores, and explores its integration into routine assessments, while identifying study limitations and future research directions.

 Methodology

A systematic literature search (2006–2023) was conducted in PubMed, Embase, and Cochrane, following PRISMA guidelines. Studies comparing ultrasound (especially PDUS) with clinical remission scores (DAS28, SDAI, CDAI) in RA were included. Three reviewers independently screened articles, with data extracted using a structured form and assessed for bias.

Narrative synthesis was used due to study heterogeneity; descriptive statistics summarized ultrasound’s sensitivity in detecting subclinical synovitis.

 Results

Ultrasound detected subclinical synovitis in 28–95% of RA patients in clinical remission, with PD signals especially common in wrists. Ultrasound remission aligned best with SDAI

 Conclusion

Ultrasound, particularly PDUS, was superior to clinical composite scores like DAS28 and CDAI in detecting subclinical synovitis. Many patients classified as in remission by DAS28 or CDAI still exhibit active disease when assessed by ultrasound. Incorporating PDUS into routine RA evaluations is critical for identifying subclinical synovitis and improving disease management. Standardized protocols and additional research are necessary to fully integrate ultrasound into clinical practice andĥ enhance patient outcome.

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