The Role of Ultrasound in Defining Remission in Rheumatoid Arthritis

Authors

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 andassessed 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

Published

2025/06/05

Issue

Vol. -issue 2
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