For Rheumatoid Arthritis Patients, Remission Does Not Always Mean Remission
It has been known for quite a while that remission from rheumatoid arthritis is not always true remission. Studies have reported continued joint damage and abnormal signals on ultrasound and MRI images in patients given an “all clear” by their doctor based on clinical assessment. Those unusual signals were never truly defined until a group of clinicians and researchers at the University of Rochester Medical Center linked them to inflammation in biopsied patient joint tissue, indicating that the disease was far from gone.
The findings, published in the Journal of Rheumatology, are important because many patients will stop taking their medications when their joint pain subsides, says Allen Anandarajah, M.B.B.S., in the Division of Allergy, Immunology, and Rheumatology. “This is a study that I can show my patients to say, ‘Look, just because you are feeling well, doesn’t mean that your rheumatoid arthritis is under complete control.’”
Anandarajah and Christopher Ritchlin, M.D., M.P.H., chief of the Division of Allergy, Immunology, and Rheumatology, collected tissue samples during elective orthopedic surgeries of rheumatoid arthritis patients in clinical remission. Inflammation was found in biopsied tissue, which paralleled abnormalities found on MRI and ultrasound images taken prior to surgery. Remarkably, most of the patient’s tissues and images showed joint inflammation and disease progression, despite their diagnosis of remission.
These outcomes suggest that confirmation of remission from rheumatoid arthritis may require the use of imaging measures in combination with clinical assessment and medical histories. Study authors recommend musculoskeletal ultrasound because it’s non-invasive, relatively inexpensive, and can be done right in the doctor’s office. This extra measure could ensure that patients do not stop taking their medications before it is safe to do so.
The study also assessed which rheumatoid arthritis drugs correlated to the lowest inflammation. While the number of patients examined was too low to draw conclusions about the most effective drugs, Anandarajah and Ritchlin believe their study shows that ultrasound and MRI could be instrumental in investigation of new rheumatoid arthritis therapies. In fact, Anadarajah plans to use these methods in his new large-scale study to assess efficacy of rheumatoid arthritis drugs.
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Susanne Pritchard Pallo |