Background/Purpose: Remission or low disease activity is the therapeutic target for rheumatoid arthritis (RA). There is a consistent body of evidence supporting the value of ultrasound in the diagnosis, disease activity and treatment monitoring of RA patients. In spite of these pieces of information, the impact of ultrasound in treatment decisions in RA patients from real clinical setting has not yet sufficiently studied. Purpose: To explore the impact of ultrasound findings, in terms of the proportion of patients in whom treatment recommendation differed after the ultrasound examination in RA outpatients. We also tested the variations of ultrasound impact according to the level of patient´s disease activity or the physician´s experience.

Methods: 85 consecutive RA outpatients were included. In the 1st step a senior rheumatologist (SR) and a trainee in rheumatology (TR), blinded to each other evaluation performed a clinical assesment that included DAS28; then, they independently proposed a treatment recommendation. In a 2nd step, all patients underwent an ultrasound examination using the 7-joints score (US-7,[2]) by an experienced rheumatologist blinded to clinical evaluation; US-7 assessed gray scale sinovitis (GS), power doppler sinovitis (PD) and accordingly determined disease activity. In the final step, all the patients returned to both, the SR and the TR, who integrated the US-7 findings to their previous evaluation and reviewed their prescription. TR and SR changes of treatment (pre- and post-US-7) were recorded on standardized formats. Patients received final recommendation only from the SR. US-7 usefulness was separately evaluated by the SR and the TR according to a Likert scale (0= not useful at all, 10= very useful). Patients signed informed consent.

Results: Patients were mainly female (91.4%), with (mean±SD) 45.13 ± 12.4 years of age and disease duration of 7.45±3.9 years. Sixty one (71.8%) patients were in DAS28-remission (<2.6), meanwhile 24 (28.2%) had some level of disease activity according to DAS28. US-7 evaluations showed that 98.8% of the patients had at least some degree of GS sinovitis and 22.6% had PD. In 34 (20%) out of the 170 clinical evaluations (85 patients concomitantly evaluated by SR and TR), US-7 modified treatment and it was most frequently increased. Interestingly, 24 out of these 34 evaluations were performed by TR vs. 10 performed by the SR: 70.5% vs. 29.5%, p=0.01. Also, US-7 usefulness was scored higher by TR than by the SR, 4.9±2.5 mm vs. 4.1±1.8, p= 0.02. Disease activity did not affect the impact of US-7 on treatment recomendation.

Conclusion: US-7 findings impacted treatment in up to 20% of RA patients assessed in routine clinical practice; this impact was greater in TR than in SR. References: 1. Naredo E, Collado P, Cruz A, Palop MJ, et al. Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. Arthritis Rheum. 2007 Feb 15;57(1):116-24. 2. Backhaus et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009;61: 1194-201

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-ultrasound-in-treatment-decision-of-rheumatoid-arthritis-assessed-in-routine-clinical-practice/