Background/Purpose: Treatment decisions in patients with Rheumatoid Arthritis (RA) after the “Treat to Target (T2T)” – principle is widely recommended, as this management strategy leads to a better outcome (1). Recently, the additional use of musculoskeletal ultrasound (US) within the T2T-strategy was recommended (2). However, superior value in terms of outcome of US- compared to the use of (only) clinical scores-guided strategy has not been demonstrated (3). To assess potential clinical and imaging markers which may have the capacity to predict changes of therapy.

Methods: In this ongoing observational study (‘Arthromark’), patients with early RA (disease duration ≤2 years) are included before therapy initiation/change and amongst others parameters are assessed by the clinical score DAS28(ESR) and by all items of the 7-joint US score (US7 score; (4)) at baseline (before therapy initiation/change), and after 1.5, 3, 6, and 12 months. At each visit, treatment decision of the antirheumatic therapy is performed according to the T2T-principle. Treatment change contains any modification of the antirheumatic therapies during the 12 months follow-up, i.e. doses escalation, combination of conventional DMARD therapies, and additional/change to biologic therapies. The following two patient groups were considered in the analysis: 1) patients that underwent any change in the antirheumatic therapy, and 2) patients that underwent none of the changes mentioned above. This analysis aimed to investigate the association between this change and the clinical (DAS28) and the ultrasound (US7) parameters at baseline. The differences between these two patient groups regarding baseline DAS28(ESR) as well as the ultrasound scores were examined applying statistical tests (Mann-Whitney-U test for continuous variables, χ²test for categorical variables). The significance level was 0.05, which was not adjusted for multiple testing. Furthermore, ROC analysis was performed to investigate the ability of these baseline variables in discriminating the two patient groups.

Results: 74 patients were included in the analysis (average age 52.37 years; 75.68% female). On average, time since first diagnosis was about half a year (max. 2.03 years). At baseline, DAS28(ESR) was 5.14 (min. 3.37, max. 7.57) on average. No statistically significant difference was shown between the two groups regarding baseline DAS28(ESR), however in terms of the baseline US7 synovitis B-mode score, the US7 synovitis Power Doppler score, and the US7 erosion score (Figure 1). These results agree with the results of the ROC analyses (Figure 2), where the AUC of the baseline US7 synovitis B-mode score, the US7 synovitis Power Doppler score, and the US7 erosion score were significantly different from 0.5, indicating that these variables can discriminate patients with and without therapeutic change well enough. According to the ROC analyses, DAS28(ESR) and the US7 tenosynovitis scores (B-mode and Power Doppler) show relatively poorer discriminating performance.

Conclusion: These analyses give a quantitative insight into the association between DAS28(ESR) and US7 score measurements at baseline and any therapeutic change during the course of the study. The results suggest that the synovitis ultrasound scores (in B-mode and Power Doppler) and the erosion score, in contrast to DAS28(ESR), might be able to predict the therapeutic change during the treatment course of patients.

References: [1] Smolen J, et al. Ann Rheum Dis 2016;75:3–15. [2] Horton S, et al. Rheumatology 2016 Published Online First [3] Dale J, et al. Ann Rheum Dis. Mar 29 2016. [4] Backhaus M, et al. Arthritis Rheum 2009; 61;1194-1201

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-7-joints-musculoskeletal-ultrasound-score-us7-score-predicts-therapeutic-change-in-patients-with-early-rheumatoid-arthritis/