Claim: residual ultrasound synovitis in RA remission flags higher flare risk, but not a stand-alone tapering rule

PubMed studies consistently show that musculoskeletal ultrasound can detect subclinical inflammation in clinically remitted RA, and that power Doppler/subclinical synovitis is associated with later flare or structural progression in several cohorts (PMID: 24929634, 27803342, 29886430, 39289028). However, one tapering cohort did not find subclinical synovitis to predict flares (PMID: 30873946), so the signal is context-dependent.

Limitation: ultrasound should be treated as an adjunct to clinical assessment, not a standalone decision rule for tapering or escalation.