Abstract and Introduction
Abstract
For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network - the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA.
Introduction
The management of rheumatoid arthritis (RA) has changed dramatically over the last few years due to the impact of improved strategies and new therapies. Early diagnosis and effective treatment of RA have been shown to improve symptom control, long-term structural damage and functional status. Rapid escalation of disease modifying antirheumatic drugs (DMARDs) and the early use of biologic agents have been central in increasing the rates of remission by rapidly controlling inflammation. European League Against Rheumatism recommendations reinforced by the treat-to-target approach have set remission as the primary treatment goal for RA in everyday clinical practice.