Power Doppler Ultrasound 7-Joint Score Vs. Simplified Disease Activity Index In Rheumatoid Arthritis Associated With Fibromyalgia

Rafael Chakr¹, Marina Behar², José A. Mendonça³, Daniela Cervantes², Nizele Calegaro², Nicole Andrade², Iuri Siqueira², Daniel Zanchet², Andrese Gasparin², Penélope Esther Palominos², Charles Kohem⁴, Odirlei Andre Monticielo⁵, Claiton Brenol⁶, Ricardo M. Xavier² and João Carlos T. Brenol⁷, ¹Rheumatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ²Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ³Rheumatology, Pontifical Catholic University of Campinas / Institute of Clinical Research – IPECC, Campinas, Brazil, ⁴Brazilian Registry of Spondyloarthritis, São Paulo, Brazil, ⁵Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ⁶Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil, ⁷Rheumatology Division, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Disease Activity, fibromyalgia, Rheumatoid arthritis (RA), ultrasonography and ultrasound

Session Information

Title: Imaging in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Fibromyalgia (FM) falsely increases rheumatoid arthritis (RA) disease activity clinical composite scores, such as the simplified disease activity index (SDAI), recently incorporated into ACR/EULAR definitions of remission in RA clinical trials (1-3). Allegedly, an objective assessment tool such as ultrasound is less prone to overestimation. The power Doppler (PDUS) US7 (0 to 39) semiquantitatively measures synovial neoangiogenesis as an objective estimation of RA disease activity. Our goal is to investigate whether PDUS US7 performs better than SDAI in disease activity evaluation among RA patients with FM.

Methods: A matched case-control study of RA women with FM (cases) and without FM (control) selected participants from a University-based arthritis clinic. Controls were matched for RA duration and rheumatoid factor positivity. Subjects with concomitant diseases potentially causing arthritis were not included. SDAI and PDUS US7 were calculated by a blinded assessor. Student´s t test of paired means and Pearson´s correlation coefficient were done for between groups comparisons. All participants signed informed consent.

Results: Thirty six cases (age = 55 ± 12.9 years, FIQ = 54.5 ± 21.1) and 36 controls (age = 55 ± 12.1 years) presented statistically different SDAI (30.6 ± 14.2 vs. 16.3 ± 10.3, P<0.001) but similar PDUS US7 (5.9 ± 4.2 vs. 5.8 ± 3.1, P>0.05). SDAI and PDUS US7 showed weak correlation among cases (r = 0.18, P>0.05) and moderate correlation among controls (r = 0.62, P<0.05). Arbitrarily considering PDUS US7 as the “gold standard” for RA disease activity assessment, SDAI had six times more false moderate/high individuals among cases as compared to controls (specificity of 54% in cases and 89% in controls).

Conclusion: PDUS US7 does not seem to be falsely increased by FM among RA patients, as opposed to SDAI. Longitudinal studies are necessary to clarify if ultrasound-based treatment decision decreases adverse events and costs in patients with RA and FM.

Disclosure:

R. Chakr,
None;

M. Behar,
None;

J. A. Mendonça,
None;

D. Cervantes,
None;

N. Calegaro,
None;

N. Andrade,
None;

I. Siqueira,
None;

D. Zanchet,
None;

A. Gasparin,
None;

P. E. Palominos,
None;

C. Kohem,
None;

O. A. Monticielo,
None;

C. Brenol,
None;

R. M. Xavier,

Pfizer, Roche and Merck,

J. C. T. Brenol,
None.

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