Original Research

The Role of Ultrasound in Defining Remission in Rheumatoid Arthritis

Masem Afzal
Gulab Devi Hospital Lahore
Muhammad Maqsood
Gulab Devi Hospital Lahore
Fahad Aman Khan
Gulab Devi Hospital Lahore
Imran Khan
Gulab Devi Hospital Lahore
Muhammad Faiq
Gulab Devi Hospital Lahore
Nauman Rafi Rajpout
Gulab Devi Hospital Lahore

✉ Correspondence: Nauman Rafi Rajpout Email: naumanrafi@hotmail.com

DOI https://doi.org/10.70302/jpsim.v6i2.2525
Volume: 6, Issue 2 Pages: 128–135 Published: 05 Jun 2025
Received: 11 Dec 2024 Revised: 20 Jan 2025 Accepted: 26 Apr 2025 Published Online: 05 Jun 2025

Abstract

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.

Methods

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 <3.3, while DAS28 often underestimated residual disease. GS and PD synovitis were also found in asymptomatic joints, highlighting limitations of clinical scores alone. Some studies showed no clinical benefit from ultrasound-guided treatment, though PD negativity predicted sustained remission in others.

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.

Keywords
Rheumatoid Arthritis Remission Induction Ultrasonography Synovitis Imaging Disease Activity

How to Cite This Article

Afzal M, Maqsood M, Khan FA, Khan I, Faiq M, Rajpout NR. The Role of Ultrasound in Defining Remission in Rheumatoid Arthritis. J Pak Soc Intern Med. 2025;6(2):128–135. doi:10.70302/jpsim.v6i2.2525

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

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CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2025 Journal of Pakistan Society of Internal Medicine.
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