Agreement Between DAS28, ACR/EULAR, SDAI, CDAI and Ultrasound Remission in Patients with Rheumatoid Arthritis Receiving Biological Treatment in Routine Care

Cecilie Heegaard Brahe¹, Lene Terslev², Simon Krabbe³, Mikkel Østergaard⁴, Henrik Rogind⁵, Hanne Jensen⁶, Annette Hansen⁷, Jesper Nørregaard⁸, Søren Jacobsen⁹, Karen Ellegaard¹⁰, Viktoria Fana¹, Lars Juul⁷, Tuan K. Huynh⁸, Dorte V. Jensen⁷, Natalia Manilo⁶, Karsten Heller Asmussen⁶, Per Brown-Frandsen⁹, Søren Tobias Torp-Pedersen¹¹, Niels Steen Krogh¹² and Merete Lund Hetland², ¹Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Denmark, Glostrup, Denmark, ²Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Denmark, Glostrup, Denmark, ³Center for Rheumatology and Spine diseases, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Denmark, Glostrup, Denmark, ⁴Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Denmark, Glostrup, Denmark, ⁵Center for Rheumatology and Spine Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Denmark, Glostrup, Denmark, ⁶Department of Rheumatology, Copenhagen University Hospital at Frederiksberg-Bispebjerg, Denmark, Frederiksberg, Denmark, ⁷Department of Rheumatology, Copenhagen University Hospital at Gentofte - Herlev, Denmark, Gentofte, Denmark, ⁸Department of Rheumatology, Copenhagen University Hospital at Nordsjælland, Denmark, Hillerød, Denmark, ⁹Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Denmark, Glostrup, Denmark, ¹⁰Department of rheumatology, Frederiksberg-Bispebjerg Hospital, The Parker Institute, Copenhagen, Denmark, ¹¹Department of Radiology, Copenhagen University Hospital at Glostrup, Denmark, Glostrup, Denmark, ¹²ZiteLab ApS, Copenhagen, Denmark

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: remission, rheumatoid arthritis (RA) 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: Different remission criteria are available for patients with rheumatoid arthritis (RA). None of the criteria includes imaging remission, even though studies have shown that many RA patients in sustained clinical remission have synovitis detectable by ultrasound (US), i.e. grey scale synovial hypertrophy and/or Doppler signal in the synovium.

We aim to investigate the agreement between different clinical remission criteria and remission defined by US in patients with RA receiving biological therapy in routine care.

Methods: A total of 117 RA patients in sustained remission (i.e. DAS28 ≤2.6 for ≥ 1 year and no radiographic progression the last year) on biological therapy were recruited. All patients underwent US of 24 joints for grading of grey scale (GS) synovial hypertrophy (0-3) and synovial Colour Doppler activity (CD) (0-3). Imaging remission was defined in two ways: either GS=0 and CD=0 in all 24 joints, or GS≤1 and CD=0 in all 24 joints.

Results: Baseline characteristics are shown in table 1. At baseline patients received the following disease-modifying antirheumatic drugs (DMARDs): methotrexate (MTX; 72%), sulphasalazine (3%), azathioprine (2%), leflunomide (2%), no DMARDs (21%) and the following treatment with biological therapy: abatacept (2%), adalimumab (28%), certolizumab (3%), etanercept (28%), golimumab (3%), infliximab (27%), tocilizumab (9%).

For patients fulfilling DAS28 remission criteria, US defined remission was present in 9% (GS=0 and CD=0 in all 24 joints, termed “very strict” US remission) or 29% (GS ≤ 1 per joint and CD=0 in all 24 joints, termed “strict” US remission) and 24% had CD>1 in at least 1 joint (table 1). For patients fulfilling other criteria for clinical remission (CDAI, SDAI and ACR/EULAR remission), patients were in very strict US remission in 12%, 12% and 10%, respectively and in strict US remission in 28%, 29% and 20%, respectively. CD activity > 1 in at least 1 joint was present in 22%, 25% and 22% of patients, respectively. The anatomical distribution of the GS synovial hypertrophy was 31% in metacarpophalangeal joints, 27% in metatarsophalangeal joints, 19% in wrists, 10% in knees, 7% in elbows and 6 % in ankles. Thus, 33% of the total GS synovial hypertrophy was observed in the feet, which are not included in the DAS28 remission criteria.

There were no significant differences in US findings (GS or CD) between patients in remission vs patients not in remission, no matter which clinical remission criteria were used.

Conclusion:

Subclinical synovitis was frequently detected by US in RA patients treated with biological drugs in routine care showing poor agreement between the clinical remission criteria and US remission. Further studies are needed to evaluate the benefit of US remission as a goal for treat to target strategies on patient-reported outcomes and radiographic progression.

Disclosure: C. H. Brahe, None; L. Terslev, UCB, 8,Abbott Laboratories, 8,MSD, 8,Pfizer Inc, 8,Roche Pharmaceuticals, 8; S. Krabbe, None; M. Østergaard, Abbott Immunology Pharmaceuticals, 9,Pfizer Inc, 9,BMS, 9,UCB, 9,Merck Pharmaceuticals, 9,Janssen Pharmaceutica Product, L.P., 9,Roche Pharmaceuticals, 9; H. Rogind, None; H. Jensen, None; A. Hansen, None; J. Nørregaard, None; S. Jacobsen, None; K. Ellegaard, None; V. Fana, None; L. Juul, None; T. K. Huynh, None; D. V. Jensen, None; N. Manilo, None; K. H. Asmussen, Abbott Laboratories, 9,Merck Pharmaceuticals, 9,Pfizer Inc, 9,Novartis Pharmaceutical Corporation, 9,UCB, 9,Berlin Chemie, 9; P. Brown-Frandsen, None; S. T. Torp-Pedersen, None; N. Steen Krogh, None; M. Lund Hetland, None.

To cite this abstract in AMA style:

Brahe CH, Terslev L, Krabbe S, Østergaard M, Rogind H, Jensen H, Hansen A, Nørregaard J, Jacobsen S, Ellegaard K, Fana V, Juul L, Huynh TK, Jensen DV, Manilo N, Asmussen KH, Brown-Frandsen P, Torp-Pedersen ST, Steen Krogh N, Lund Hetland M. Agreement Between DAS28, ACR/EULAR, SDAI, CDAI and Ultrasound Remission in Patients with Rheumatoid Arthritis Receiving Biological Treatment in Routine Care [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/agreement-between-das28-acreular-sdai-cdai-and-ultrasound-remission-in-patients-with-rheumatoid-arthritis-receiving-biological-treatment-in-routine-care/. Accessed .

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