Session Information
Date: Sunday, November 13, 2016
Title: Rheumatoid Arthritis – Clinical Aspects - Poster I: Clinical Characteristics/Presentation/Prognosis
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Patient global assessment (PtGA), despite not being exclusively related to disease activity, is included in Boolean-based remission (BR) criteria for RA. This study evaluated the US disease activities, sustainabilities, and relapse rates of RA patients in BR by using physician (Ph) GA (BR-PhGA) compared to those in BR by using PtGA (BR-PhGA).
Methods: Established RA patients in clinical remission (DAS28-ESR<2.6) for ≥6 months with a stable treatment regimen were included. Fulfillment of BR-PtGA and BR-PhGA criteria were assessed. A standard gray scale (GS) and power Doppler (PD) US examination of 28 joints (included in DAS28) for the presence of synovitis was performed at baseline and 6th month (NI). GS and PD synovitis signals were semiquantitatively graded from 0 to 3. US disease activity was also categorized as US remission (PD-/GS-), inactive synovitis (PD-/GS+), and active synovitis (PD+/GS+). Clinical relapse (1. Loss of DAS28 remission; 2. Loss of BR) and US relapse (Loss of US remission due to 1. Any increase in PG/GS scores; 2. Only grade≥2 increase in PD/GS scores) rates (each of 4 definitions) were determined at 6th month.
Results: 96 out of 398 (24.1%) RA patients in DAS28 remission were enrolled (F/M=60/36, age 53±12, disease duration 11±5 yrs, bDMARDs 43%, RF/Anti-CCP positivity 83%). BR-PtGA was fulfilled in 37 (38.5%) and 31 (32.3%) patients and BR-PhGA was fulfilled in 61 (63.5%) and 66 (68.8%) patients at baseline and 6th month, respectively. Baseline US disease activities of patients in BR-PtGA and BR-PhGA were not significantly different (Table 1). PD and GS scores of patients in BR-PtGA were similar to those of not fulfilling BR-PtGA. However, patients in BR-PhGA had significantly lower PD and GS scores compared to non-remission counterparts, 0 (1-4) vs 4 (2-7), P=0.001; 3 (0-7) vs 6 (3-10), P=0.003, respectively. Loss of DAS28 remission rates were similar in both BR groups (16.2% vs 18%, P=0.82), whereas loss of corresponding BR was slightly lower in BR-PhGA patients (38% vs 21%, P=0.08). US relapse rates in BR-PtGA and BR-PhGA patients who were in US remission at baseline (loss of US remission: 3/10 vs 7/15, P=0.41; loss of US remission due to grade≥2 increase in PD/GS score: 1/16 vs 6/20, P=0.16), and changes in US disease activities over time were also comparable (Table 2).
Conclusion: US verified disease activity of patients in BR-PhGA is similar to patients in BR-PtGA. BR-PhGA differentiates US inflammation better than the BR-PtGA with higher sustainability and similar US relapse rates. PtGA may be substituted with PhGA in BR, particularly in established RA patients.
| Table 1. Baseline clinical characteristics and ultrasonographic disease activities of patients in BR- PtGA and BR-PhGA* | |||
|
Boolean REM with PtGA (n=37) |
Boolean REM with PhGA (n=61) |
P value |
|
| Age, mean±SD years |
53.4±13.9 |
53.2±13.1 |
0.94 |
| Female, % |
62.2 |
62.3 |
0.99 |
| Education level, mean±SD years |
6.9±3.9 |
6.8±3.6 |
0.88 |
| Disease duration, mean±SD years |
10.4±5.0 |
10.4±5.2 |
0.98 |
| RF/Anti-CCP positivity, % |
83.8 |
82.0 |
0.82 |
| Currently on biologic DMARDs, % |
40.5 |
41.0 |
0.96 |
| Currently on glucocorticoids, % |
13.5 |
14.8 |
0.86 |
| HAQ (0-3) |
0.12 (0-0.69) |
0.12 (0-0.50) |
0.55 |
| DAS28-ESR, mean±SD |
2.08±0.44 |
2.10±0.43 |
0.81 |
| PD synovitis sum score (0-84) |
1 (0-4.5) |
1 (0-4) |
1.0 |
| PD synovitis sum scores (without grade 1 signals) |
0 (0-4) |
0 (0-3) |
0.99 |
| GS synovitis sum score (0-84) |
4 (0-7) |
3 (0-7) |
0.93 |
| GS synovitis sum scores (without grade 1 signals) |
2 (0-5.5) |
2 (0-5.5) |
0.82 |
| US remission (PD-/GS-), %
PD-/GS- without grade 1 signals |
27 43.2 |
24.6 44.3 |
0.79 0.92 |
| Inactive synovitis (PD-/GS+), %
PD-/GS+, only with grade ≥2 GS signals |
10.8 16.2 |
11.5 14.8 |
0.92 0.84 |
| Active synovitis (PD+/GS+), %
PD+/GS+, only with grade ≥2 signals |
62.2 40.5 |
63.9 41 |
0.86 0.96 |
| US erosion, % |
67.6 |
70.5 |
0.76 |
| US tenosynovitis, % |
21.6 |
21.3 |
0.97 |
| *The values were presented as median (IQR) unless indicated otherwise. | |||
| Table 2. Change between baseline and 6th month of clinical and ultrasonographic findings of patients in BR-PtGA and BR-PhGA* | ||
|
Boolean REM with PtGA (n=37) |
Boolean REM with PhGA (n=61) |
|
| DDAS28 |
0.20 (0.40) |
0.24 (0.59) |
| DHAQ |
-0.1 (0.4) |
-0.1 (0.4) |
| DPD synovitis sum score |
-0.2 (2.1) |
-0.3 (2.4) |
| DGS synovitis sum score |
-0.5 (2.8) |
-0.6 (3.1) |
| Change in PD scores, %
Decreased Not changed Increased
|
35.1 37.8 27.0
|
36.1 32.8 31.1 |
| Change in PD scores (without grade 1 changes), %
Decreased Not changed Increased
|
27.0 54.1 18.9 |
29.5 49.2 21.3 |
| Change in GS scores,%
Decreased Not changed Increased |
48.6 21.6 29.7
|
49.2 21.3 29.5 |
| Change in GS scores (without grade 1 changes), %
Decreased Not changed Increased |
27.0 56.8 16.2 |
29.5 50.8 19.7 |
| No. of patients who were not in US remission (PD-/GS-) at baseline
Achievement of US remission at 6th month, % |
27 18.5 |
46 15.2 |
| No. of patients who were not in US remission (PD-/GS- without g rade 1 signals) at baseline Achievement of US remission at 6th month, % |
21 19.0 |
35 31.4 |
| *The values were presented as mean (SD) unless indicated otherwise. All P values>0.05 | ||
To cite this abstract in AMA style:
Ozen G, Unal AU, Direskeneli H, Inanc N. Boolean-Based Remission in Rheumatoid Arthritis Using Physician Versus Patient Global Assessment: Differences in Ultrasonographic Disease Activities, Sustainabilities, and Relapse Rates [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/boolean-based-remission-in-rheumatoid-arthritis-using-physician-versus-patient-global-assessment-differences-in-ultrasonographic-disease-activities-sustainabilities-and-relapse-rates/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/boolean-based-remission-in-rheumatoid-arthritis-using-physician-versus-patient-global-assessment-differences-in-ultrasonographic-disease-activities-sustainabilities-and-relapse-rates/