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: Ultrasonography (US) has become a support tool for the daily management of rheumatologic patients. However, when and how to use it remains a subject of discussion. Objective:To determine the added value of articular US joint count, compared to clinical joint count for measuring disease activity in patients with rheumatoid arthritis (RA).
Methods: A cross-sectional study including patients with diagnosis of RA (ACR-EULAR 2010) was designed. Patients underwent clinical and US assessment. The clinical examination included 28 joint count visual analog scale (VAS) for global disease activity and erythrocyte sedimentation rate (ESR). Ultrasound evaluation was conducted by two rheumatologists with experience in US who were blind to clinical examination, and included the assessment of 28 joints (according to the DAS28 index). The Power Doppler (PD) signal and gray-scale (GS) were graded from 0-3, according to the OMERACT standards. Swollen joint counts were calculated according to five criteria: One clinical count (Clinical) and four US counts. For the latter, joint swelling was defined according to different standards: a) US Global-OMERACT (PD≥1 presence and / or EG≥1); b) Presence of PD≥1 (US- PD1); c) Presence of PD≥2 (US-PD2); d) Presence of PD = 3 (US-PD3). Additionally DAS28 and the percentage of patients in remission (DAS28≤2.6) were calculated for each joint count criteria.
Results:
We included a total of 49 consecutive RA patients. The mean disease duration was 8 ± 5 years, 85% were women, with a mean age of 53 ± 10 years.
Table 1 shows the different joint counts and their resulting activity rates. The use of the US Global-OMERACT criteria was the method that most frequently detected inflammation. The US swollen joint counts using only the degree of signal PD were not superior to clinical evaluation in the detection of patients with active disease.
|
Different SJC (28 joints) |
SJC (Mean ± SD) |
p* |
DAS28 (calculated according to different joint counts) |
p& |
Remission (according to DAS28) |
|
Clinical |
5.6 ± 4.8 |
0.01 |
4.8 ± 1.5 |
<0.01 |
3 (6%) |
|
US-OMERACT |
15.6 ±6.1 |
5.3 ± 1.3 |
0 (0%) |
||
|
US-PD1 |
5.9 ± 4.9 |
4.8 ± 1.5 |
3 (6%) |
||
|
US-PD2 |
3.2 ± 3.3 |
4.6 ± 1.4 |
4 (8%) |
||
|
US-PD3 |
0.4 ± 0.8 |
4.3 ± 1.3 |
5 (10%) |
SJC: swolen joint count
* US-OMERACTwas significantly higher than the other joint counts. & The DAS28 calculated according to US-PD3 count was significantly lower than that calculated by the US-OMERACT.
Conclusion:
In our study US evaluation according to OMERACT criteria was the most sensitive method to detect joint inflammation. However, clinical joint count demonstrated to be a reliable method. Only 6% of patients classified in remission according to clinical examination, were reclassified as active after US assessment. Furthermore, the use of PD signal without GS quantification did not show superiority over clinical examination for the detection of patients with disease activity.
To cite this abstract in AMA style:
Cazenave T, Waimann CA, Citera G, Rosemffet MG. Ultrasonographic Joint Evaluation in Daily Practice: What Is Its Contribution to Clinical Assessment? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/ultrasonographic-joint-evaluation-in-daily-practice-what-is-its-contribution-to-clinical-assessment/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonographic-joint-evaluation-in-daily-practice-what-is-its-contribution-to-clinical-assessment/