Residual Synovitis in Ultrasound (US) Is Associated with an Evolution Towards Rheumatoid Arthritis (RA) in Patients with Inflammatory Polyarthralgia without ANTI-Citrulinated Antibodies (ACPA)

Pascal Zufferey^1,2,3, Claudia Rebell Jr.⁴, Alexandre Dumusc⁵, Mauro lucini⁴, Juerg Hains⁶, Alexander K. So Sr.⁷ and Charles Benaim⁸, ¹Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, ²Pierer Decler, Chuv, Lausanne, Switzerland, ³Rhu /Dal .Chuv, Rheumatology, Lausanne, Switzerland, ⁴DAL, RHU/CHUV, lausanne, Switzerland, ⁵RHU/CHUV, lausanne, Switzerland, ⁶DAL, RHU/CHUV, Lausanne, Syria, ⁷Service De Rhumatologie, CHUV, Lausanne, Switzerland, ⁸DAL, MPR, Lausanne, Switzerland

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ACPA, Diagnostic criteria, polyarthritis, synovitis and ultrasound

Session Information

Date: Sunday, November 8, 2015

Title: Imaging of Rheumatic Diseases Poster I: Ultrasound, Optical Imaging and Capillaroscopy

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

In ACPA positive patients, subclinical synovitis as observed
by US has been demonstrated in pre RA patients and seems to be predictive for
future development of RA [1]. No such study has yet been conducted in ACPA
negative patients.

The primary aim of the study was to assess the value of the
US as a screening tool to detect early joint involvement in ACPA- patients
complaining of polyarthralgia and to analyse whether such subclinical synovitis
is predictive for the future development of an inflammatory disease, in
particular RA. The secondary aims were to look for additional clinical and
biological predictors of RA development in ACPA- patients

Methods:

This is a retrospective observational study of 101
consecutive ACPA- patients with poly-arthralgia who did not meet the ACR /
EULAR 2010 criteria for RA or classification criteria for another inflammatory
rheumatology disease before the US examination. These patients were all seen in
investigation in our ambulatory unit between 2009 and 2013. To detect
significant US synovitis, we applied the criteria of the SONAR score validated
among RA patients and controls [2](total B mode score >8, > 2 synovitis:
grade 2). For the follow-up, the same diagnostic criteria as baseline were
used.

Results:

At baseline (30%) had significant synovitis according to the
SONAR criteria. The mean (SD) follow-up time was 18 (7) months in both groups.
17 patients developed a clear inflammatory arthritis (11 RA, 6 another
inflammatory arthritis disease). Significant US synovitis at baseline was
significantly associated with evolution to RA: 7/28 versus 4/69 (<0.005),
sensitivity: 64% specificity: 76%, LR: 2.7. Elevated CRP and clinical synovitis
appeared to be additional predictors of such an evolution. Figure depicts the
arthritis free curves (a: before RA, b: before all inflammatory arthritis)
according to the presence or not of US synovitis at baseline

Conclusion:

Our study suggests that US can be used as a predictor for
the evolution to RA in patients presenting inflammatory polyarthralgia without
ACPA.

References: 1: Ann Rheum Dis 2010; 69:417–419, 2: Joint
Bone Spine. 2014 Oct;81(5):426-32

Disclosure: P. Zufferey, None; C. Rebell Jr., None; A. Dumusc, None; M. lucini, None; J. Hains, None; A. K. So Sr., None; C. Benaim, None.

To cite this abstract in AMA style:

Zufferey P, Rebell C Jr., Dumusc A, lucini M, Hains J, So AK Sr., Benaim C. Residual Synovitis in Ultrasound (US) Is Associated with an Evolution Towards Rheumatoid Arthritis (RA) in Patients with Inflammatory Polyarthralgia without ANTI-Citrulinated Antibodies (ACPA) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/residual-synovitis-in-ultrasound-us-is-associated-with-an-evolution-towards-rheumatoid-arthritis-ra-in-patients-with-inflammatory-polyarthralgia-without-anti-citrulinated-antibodies-acpa/. Accessed .

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