TY - JOUR T1 - Chasing the Ghost of Imaging Remission in Rheumatoid Arthritis JF - The Journal of Rheumatology JO - J Rheumatol SP - 881 LP - 883 DO - 10.3899/jrheum.180035 VL - 45 IS - 7 AU - GURJIT S. KAELEY AU - VEENA K. RANGANATH Y1 - 2018/07/01 UR - http://www.jrheum.org/content/45/7/881.abstract N2 - The role of musculoskeletal ultrasound (MSK-US) in rheumatoid arthritis (RA) is evolving, albeit with twists and turns. Early RA randomized clinical studies have demonstrated little added value of MSK-US when used prospectively in a treat-to-target strategy1,2. Recent editorials have discussed the issues of clinical trial design and standardization US measures raised by these studies3,4.Ostensibly the goal of therapy in RA is to achieve remission and hence halt progression of erosions, as well as to maintain function. However, sustained remission is not obtained in the majority of patients with established RA5. Further, despite more stringent composite and Boolean remission criteria, progression of erosions still occurs regardless of applied clinical remission criteria6,7,8.Progression of erosions in subjects in remission is considered a result of subclinical synovitis. MSK-US can be used at the bedside to gauge residual synovitis in many joint areas. In metaanalyses of heterogeneous RA populations in clinical remission, the prevalence of greyscale and Doppler-positive subjects was estimated at 43%9. Residual synovitis prevalence was comparable even when using alternate definitions of remission. Power Doppler seems to be the key component of imaging synovitis linked to progression of erosions9,10. Of note in the 4 studies included for structural progression, definition of progression ranged from change of total Sharp score of greater than zero to greater than the smallest detectable difference9,10. In addition, prevalence of residual synovitis was higher in patients … Address correspondence to Dr. G.S. Kaeley, University of Florida College of Medicine, Division of Rheumatology, PO Box 162, Ponte Vedra, Florida 32004, USA. E-mail: drgurj{at}gmail.com ER -