Imaging Remission By Musculoskeletal Ultrasound Leads to a Better Functional Outcome - Results of the US Impera Study - US 7-Score Implementation Study in Early Rheumatoid Arthritis

Anne-Marie Glimm¹, Sarah Ohrndorf², Imma Fischer³, Johannes Strunk⁴, Wolfgang A. Schmidt⁵, Wolfgang Hartung⁶, Herbert Kellner⁷, Horst Sattler⁸, Gabriela Schmittat¹, GR Burmester⁹ and Marina Backhaus¹⁰, ¹Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany, ²Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany, ³Biostatistik Tuebingen, Tuebingen, Germany, ⁴Department of Rheumatology, Hospital 'Porz am Rhein', Academic Hospital of the University of Cologne, Cologne, Germany, ⁵Medical Center for Rheumatology and Clinical Immunology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany, ⁶Department of Rheumatology and Clinical Immunology, Asklepios Klinik Bad Abbach, Bad Abbach, Germany, ⁷Department of Internal Medicine – Rheumatologic Day Clinic, Krankenhaus Neuwittelsbach, Academic Hospital of Ludwig-Maximilians-University Munich, Munich, Germany, ⁸Internal Medicine and Rheumatology Practice, Bad Duerkheim, Bad Duerkheim, Germany, ⁹Charité – University Medicine Berlin, Berlin, Germany, ¹⁰Department of Rheumatology & Immunology, University Medicine Charit, Berlin, Germany

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Biologics, DMARDs, rheumatoid arthritis (RA) and ultrasound

Session Information

Date: Sunday, November 13, 2016

Title: Imaging of Rheumatic Diseases - Poster I: Ultrasound and Emerging Technologies

Session Type: ACR Poster Session A

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

Background/Purpose: Novel treat-to-target strategies present new challenges to treatment monitoring in rheumatoid arthritis (RA). To compare functional outcomes in early RA patients monitored by standard of care alone (clinical cohort) or with an additional musculoskeletal ultrasound examination (US cohort) following a treat-to-target strategy in a nationwide investigator-initiated study in Germany.

Methods: Functional, clinical and laboratory parameters monitored over 18 months in both cohorts were: Health Assessment Questionnaire (HAQ), Disease Activity Score 28 (DAS28), Visual Analogue Scale (VAS), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Ultrasound remission criteria used in the US cohort were: gray-scale ultrasound (GSUS) <2 at joint level and power Doppler ultrasound (PDUS) = 0. We additionally compared HAQ, DAS28, VAS, ESR and CRP in US cohort subgroups with and without ultrasound remission.

Results: In all 313 patients (US cohort: n=166, clinical cohort: n=147), laboratory activity, DAS28, VAS and HAQ decreased to low-disease activity levels within 18 months after the beginning or change of antirheumatic therapy, with no significant differences between groups. However, US cohort members with ultrasound remission (n=79) had significantly lower HAQ (0.401 vs. 0.741, p=0.002), DAS28 (2.2 vs. 3.4, p<0.001) and VAS disease activity scores (16.6 mm vs. 33.9 mm, p<0.001) than those without ultrasound remission (n=87).

Conclusion: Treat-to-target strategies reduced disease activity and improved functional outcomes (HAQ) in our early RA patients, irrespective of the monitoring regimen. However, patients with ultrasound remission had significantly better disease activity scores and functional outcomes. Accordingly, ultrasound should be strongly considered as an additional monitoring tool in clinical practice.

Disclosure: A. M. Glimm, None; S. Ohrndorf, None; I. Fischer, None; J. Strunk, None; W. A. Schmidt, Abbvie, 5,Berlin Chemie, 5,GlaxoSmithKline, 5,Lilly, 5,Novartis Pharmaceutical Corporation, 5,Roche Pharmaceuticals, 5,Abbvie, 8,Berlin Chemie, 8,Medac, 8,Merck Pharmaceuticals, 8,Novartis Pharmaceutical Corporation, 8,Pfizer Inc, 8,Roche Pharmaceuticals, 8,UCB, 8,Abbvie, 2,GlaxoSmithKline, 2,Novartis Pharmaceutical Corporation, 2,Roche Pharmaceuticals, 2; W. Hartung, None; H. Kellner, None; H. Sattler, None; G. Schmittat, None; G. Burmester, UCB, 2,AbbVie, 5,BMS, 5,Hexal, 5,Janssen Pharmaceutica Product, L.P., 5,Lilly, 5,MSD, 5,MadImmune, 5,Novartis Pharmaceutical Corporation, 5,Pfizer Inc, 5,Roche Pharmaceuticals, 5,AbbVie, 8,BMS, 8,Hexal, 8,MSD, 8,Novartis Pharmaceutical Corporation, 8,Pfizer Inc, 8,Roche Pharmaceuticals, 8; M. Backhaus, None.

To cite this abstract in AMA style:

Glimm AM, Ohrndorf S, Fischer I, Strunk J, Schmidt WA, Hartung W, Kellner H, Sattler H, Schmittat G, Burmester G, Backhaus M. Imaging Remission By Musculoskeletal Ultrasound Leads to a Better Functional Outcome – Results of the US Impera Study – US 7-Score Implementation Study in Early Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/imaging-remission-by-musculoskeletal-ultrasound-leads-to-a-better-functional-outcome-results-of-the-us-impera-study-us-7-score-implementation-study-in-early-rheumatoid-arthritis/. Accessed .

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/imaging-remission-by-musculoskeletal-ultrasound-leads-to-a-better-functional-outcome-results-of-the-us-impera-study-us-7-score-implementation-study-in-early-rheumatoid-arthritis/