Background/Purpose:

The composite scores DAS28, CDAI and SDAI all include number of tender and swollen joints (of 28). Rheumatoid arthritis (RA) patients with tender to swollen joint count difference (TSJD) >0 had reduced composite score remission and TSJD of ≥7 was shown to have ≥ 80% sensitivity and specificity to have “fibromyalgic RA” (FM-RA) (Pollard et al. Rheumatology 2010). Ultrasonography (US) is a sensitive imaging technique to detect synovitis including grey scale synovitis (GS) and power Doppler (PD) activity. The present purpose was to explore the impact of FM-RA on the composite scores in comparison to other clinical assessments including US in a longitudinal study of established RA patients initiating bDMARD therapy.

Methods:

A total of 209 patients with RA (mean (SD) age 53 (13) years, disease duration 10 (9) years, 81% women, 79% anti-CCP positive) were included when initiating bDMARDs and assessed at baseline and after 1, 2, 3, 6 and 12 months with joint pain VAS, patient’s global VAS, RAID score, MHAQ, clinical examinations (performed by a study nurse; assessor’s disease activity VAS, tender and swollen joint counts (of 28) and laboratory variables (ESR and CRP). All US examinations (semi-quantitative scoring (0-3)) of GS and PD (PIP 2-3, MCP 1-5, wrist (radiocarpal, intercarpal, radioulnar), elbow, knee, tibiotalar, MTP 1-5 and ext.carpi ulnaris/tib.post.tendons bilaterally) were performed by one rheumatologist (HBH) (Siemens Acuson Antares, excellence version, 5-13 MHz probe). To explore the impact of tender minus swollen joint count, patients were divided into three groups depending on TSJD at baseline; Gr.1=≤0 (n=125), Gr.2=1-6 (n=62), Gr.3=≥7 (n=22, FM-RA). Statistical calculations included frequency of DAS28(ESR), CDAI, SDAI and ACR/EULAR (Boolean) remission, one-way ANOVA and cross-tabs.

Results:

There were significantly higher DAS28(ESR), CDAI, SDAI, joint pain VAS, patient’s global VAS, RAID score and M-HAQ in the FM-RA group at all time points (p≤0.003), while there were no differences between the groups regarding assessor’s global VAS or ESR/CRP. On the other hand, sum scores GS and PD were higher in Gr.1 and 2 (figure 1). The table illustrates that the FM-RA group has a very low percentage of composite score remission both at 6 and 12 months follow-up.

Conclusion:

In spite of having the lowest degree of US pathology, the 10.5% FM-RA patients had significantly higher levels of all the commonly used composite scores at all time points and they seldom reached remission. Thus, the small RA-FM group should be identified and other than composite scores should be used for assessing their disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-fibromyalgic-ra-on-composite-scores-results-from-a-longitudinal-study-of-ra-patients-initiating-bdmard-therapy/