Rheumatoid Arthritis Clinical Trial
Official title:
Impact of the Persistence of Inflammation at Doppler Ultrasound Level on the Structural Evolution of Erosion in Rheumatoid Arthritis Treated With Biotherapy
Since biological disease-modifying anti-rheumatic drugs (bDMARDs) are available in rheumatoid
arthritis (RA) strategy an emerging question is the definition of remission in RA. Today some
criteria were already proposed and the last one was proposed in 2011.
All these criteria integrated only clinical criteria without imaging assessment. In this
context, ultrasound joint is daily performed without definition of remission. A discrepancy
exists between clinical remission and persistence of active disease with ultrasound joint
presence of a Doppler effect indicating inflammation and the risk of progression of joint
damage. A definition of remission in RA could include erosions regression in subchondral bone
(at best measured by high resolution peripheral quantitative computed tomography (HR-pQCT)).
The main hypothesis is that the reduction of erosion size assessed by HR-pQCT will be
observed only in the absence of local inflammation measured by Doppler ultrasound in the
erosion.
Tumor Necrosis Factor (TNF) blockers have strongly improved RA therapy outcome in terms of
clinical improvement and structural damage (progression of radiographic lesions). Recent data
showed that there could be joint bone rebuilt in case of inflammation suppression. HR-pQCT is
a new technique emerging for bone erosions assessment in RA. Erosions size and volume could
be reduced with anti-TNF, but with a large interindividual variability. There was no
correlation between the activity of clinical or ultrasound synovium and evolution of erosion
HR-pQCT.
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