Anti-CCP Positive Patients without Clinical Synovitis Progress If Ultrasound Positive

Jackie L. Nam¹, Elizabeth M.A. Hensor¹, Laura Hunt¹, Philip G. Conaghan², Richard J. Wakefield¹ and Paul Emery³, ¹NIHR-Leeds Musculoskeletal Biomedical Research Unit and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, ²University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, United Kingdom, ³NIHR-Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, United Kingdom

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: anti-CCP antibodies, inflammatory arthritis, Rheumatoid arthritis (RA), ultrasonography and ultrasound

Session Information

Date: Sunday, November 8, 2015

Session Title: Imaging of Rheumatic Diseases Poster I: Ultrasound, Optical Imaging and Capillaroscopy

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

To determine whether ultrasound can identify which anti-cyclic citrullinated peptide (anti-CCP) antibody positive patients with musculoskeletal (MSK) symptoms and without clinical synovitis progress to inflammatory arthritis (IA).

Methods:

In a prospective study, anti-CCP positive patients with new nonspecific MSK symptoms and no clinical synovitis underwent imaging with ultrasound of 32 joints (wrists, MCPs and PIPs of the hands and MTPs of the feet) and were monitored for the development of IA. Grey scale (GS) and power Doppler (PD) findings were scored 0-3 using a standard semi-quantitative method. Cox proportional hazards regression was used to measure associations between (1) the baseline ultrasound findings and subsequent diagnosis of IA using the set of 32 joints and (2) the baseline ultrasound findings within each joint and subsequent development of clinical synovitis within that joint.

Results:

Consecutive patients (n=136; mean age 51 years, 100 females) were followed up for median 18.3 months (range 0.1-79.6). At baseline, 96% had GS and 30% had PD signal in ≥1 joint(s). IA developed in 57(42%) patients after median 8.6 months (range 0.1-52.4). Patients with PD≥2 were at higher risk of progression to IA than those without PD [75% (15/20) vs. 31.9% (29/91), hazard ratio (HR) (95% CI) = 3.7(2.0, 6.9), p<0.001], and progression occurred earlier (median 7.1 vs. 52.4 months). Patients who scored GS ≥2 in the wrists and/or hands at baseline were at higher risk of developing IA than those with no GS in those joints [HR (95% CI) = 2.3(1.0, 4.9), p=0.038]. At the individual joint level, the trend for progression to clinically-detected synovitis was more significant [HR (95% CI) = 31.3(15.6, 62.9), p<0.001 for PD≥2 and HR (95% CI) = 9.4(5.1, 17.5), p<0.001 for GS≥2].

Conclusion:

Ultrasound features of joint inflammation may be detected in anti-CCP positive patients with MSK symptoms without clinical synovitis. Our findings suggest that ultrasound findings predict progression to clinical disease. The risk of clinically-detected synovitis is particularly high in joints showing power Doppler signal.

Disclosure: J. L. Nam, None; E. M. A. Hensor, None; L. Hunt, None; P. G. Conaghan, None; R. J. Wakefield, None; P. Emery, None.

To cite this abstract in AMA style:

Nam JL, Hensor EMA, Hunt L, Conaghan PG, Wakefield RJ, Emery P. Anti-CCP Positive Patients without Clinical Synovitis Progress If Ultrasound Positive [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/anti-ccp-positive-patients-without-clinical-synovitis-progress-if-ultrasound-positive/. Accessed December 11, 2019.

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