Relationship between the prevalence of subclinical tenosynovitis and treatment in patients with RA in clinical remission: STARTER study

Parisi S.;Zanetti A.;Carrara G.;Scire C. A.;Iagnocco A.;Filippou G.;Batticciotto A.;Floris A.

Investigation

;Bortoluzzi A.;Gabba A.;Gattamelata A.;Adinolfi A.;Raffeiner B.;Venditti C.;Mastaglio C.;Scioscia C.;Rossi D.;Bellis E.;Luccioli F.;Cavatorta F. P.;Ceccarelli F.;Sakellariou G.;Cagnotto G.;Farina I.;Menza L.;Idolazzi L.;Canzoni M.;Massarotti M.;Focherini M. C.;Caprioli M.;Gutierrez M.;Draghessi A.;Piga M.

Investigation

;Muratore M.;De Lucia O.;Rossini P.;MacChioni P.;Ramonda R.;Rossi S.;Di Sabatino V.;Picerno V.

2023-01-01

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Abstract

Objective: This study is a sub-analysis from the patient cohort of the STARTER (Sonographic Tenosynovitis Assessment in RheumaToid arthritis patiEnts in Remission) study. The aim was to evaluate differences in ultrasound-detected joint and/or tendon involvement between patients receiving therapies based on a combination of conventional synthetic DMARDs (csDMARDs) and biologic DMARDs (bDMARDs) and those who were treated with either csDMARDs or bDMARDs in monotherapy. Material and methods: Four hundred and twenty-seven consecutive patients with a diagnosis of RA were recruited between October 2013 and June 2014. They were divided into three subgroups based on their therapy at baseline: patients with bDMARD in monotherapy, patients with csDMARD in monotherapy and patients in combination therapy (csDMARD + bDMARD). At baseline, 6 months and 12 months, a clinical examination (28 joint count) and an ultrasound evaluation were performed in each patient. A score of grey-scale (GS) and power Doppler (PD) synovitis and tenosynovitis was calculated based on the OMERACT scoring systems. Results: Two hundred and fifty-six patients completed the observation period: 48 patients from the bDMARD group (18.75%), 152 patients from the csDMARD group (59.38%) and 56 patients from csDMARD + bDMARD group (21.88%). The analysis showed that GS tenosynovitis and PD tenosynovitis are better controlled in combination therapy than they are ith csDMARD alone (P=0.025 and P=0.047, respectively); for PD synovitis, there was a better response in those who were treated with the combination therapy when compared with the patients receiving csDMARD (P=0.01) or bDMARD (P=0.02) alone. Conclusions: The analysis showed a lower prevalence of subclinical inflammatory manifestations detected with ultrasound imaging in those patients treated with the combination therapy than in those in monotherapy.