Session Type: Abstract Submissions (ACR)
Accurate monitoring of disease activity in early PsA is limited by the potential underestimation of inflammation by clinical examination, the absence of disease-specific biochemical markers and heterogeneity of clinical manifestations. Sensitive and reliable diagnostic modalities enabling visualization of early inflammatory changes are considered as useful tools for monitoring the response to therapy. The aims of this prospective study were to assess the utility of musculosceletal ultrasound (US) in detection of inflammatory changes in early PsA and to analyze the association of changes in a semiquantitative ultrasound score on the overall clinical response, defined by EULAR response criteria and MDA (minimal disease activity).
51 patients with early PsA (onset of symptoms <5 years) naive to immunosuppressive treatment were eligible for study inclusion (disease duration 18.6 months). Patients were evaluated by US and clinically (baseline, 3/6/12 months). In each patient, 56 joints were examined by Grey-Scale-US (GSUS) and power doppler (PDUS). US findings were scored separately on a 0-3 semi-quantitative scale. US synovitis score was calculated by adding the GSUS and PDUS scores for all joints examined. Clinical assessment included TJC68, SJC66, VAS for disease activity (patient/physician), DAS28-CRP, LDI, HAQ and CRP. Treatment was initiated and modified at the discretion of the primary rheumatologist following international recommendations. Criteria for EULAR response and minimal disease activity (MDA) (Coates L. et al.) were defined for each follow-up period.
Clinical responders were more likely to have higher US scores and PDUS scores at baseline and showed a significantly higher relative reduction of the mean US synovitis and the mean PDUS score during follow-up intervals compared to non-responders. A reduction of the ultrasound score after 3 months of systemic treatment was predictive for achieving or maintaining a good/moderate EULAR response (OR 3.64, p=0.21) or MDA respectively (OR 6.01, p=0.05) after 6 and 12 months. Reduction of ultrasound inflammatory activity during systemic treatment was not only detected in symptomatic joints but also in those joints with subclinical inflammation, however clinical responders showed a tendentially larger relative reduction of subclinical synovitis than non-responders.
Reduction of inflammatory changes detected by US during systemic treatment allows discrimination between clinical responders and non-responders (defined by EULAR response criteria and MDA) in early PsA. A reduced US synovitis score 3 months after initiation of treatment is predictive for a favourable clinical outcome after 6 and 12 months. Longitudinal analysis of subclinical synovitis in responders and non-responders reveal evidence that subclinical US findings have to be regarded as a pathophysiologically relevant pre-stage of clinical synovitis.
A. P. Nigg,
A. M. Malchus,
J. C. Prinz,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-reduction-in-ultrasound-synovitis-score-discriminates-between-clinical-responders-and-non-responders-and-is-predictive-for-a-favourable-clinical-outcome-in-early-psoriartic-arthritis/