In Patients with Rheumatoid Arthritis in Clinical Remission Undergoing Treatment Tapering Tenosynovitis and Synovitis Detected By Ultrasonography Predict Disease Flare

Antonella Adinolfi¹, Giovanni Cagnotto², Filippo Luccioli³, Claudio Mastaglio⁴, Giulia Mirabelli³, Daniela Rossi⁵, Silvia Rossi², Emanuela Bellis⁶, Greta Carrara⁷, Carlo Alberto Scirè⁸, Annamaria Iagnocco⁹ and Garifallia Sakellariou², ¹Policlinico le Scotte, Siena, Italy, ²University of Pavia, IRCCS Foundation Policlinico S. Matteo, Pavia, Italy, ³University of Perugia, Perugia, Italy, ⁴Moriggia-Pelascini, Gravedona, Italy, ⁵Department of Medicine and Experimental Oncology, CMID - Center of Research of Immunopathology and Rare Diseases, Turin, Italy, ⁶Rheumatology, Ospedale Mauriziano, Turin, Italy, ⁷Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy, ⁸Epidemiology Unit -Italian Society for Rheumatology, Milano, Italy, ⁹Sapienza University of Rome, Rome, Italy

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: prognostic factors, remission, rheumatoid arthritis (RA) and ultrasonography

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster III: Treatment – Monitoring, Outcomes, Adverse Events

Session Type: ACR Poster Session C

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

Background/Purpose:

Ultrasound (US) detected synovitis predicts flare in patients with rheumatoid arthritis (RA), while the role of tenosynovitis has yet to be established. The aim of this study was to investigate the predictive role of US tenosynovitis and synovitis over disease flare in patients with RA in clinical remission in which treatment is tapered.

Methods:

STARTER is a multicentre cohort study of the US Study Group of the Italian Society for Rheumatology, involving rheumatologists selected by a reliability exercise and the availability of high-end equipment and high frequencies probes. At the beginning of the study, patients with RA in clinical remission were clinically evaluated. US synovitis (S) and tenosynovitis (T) were assessed categorically for Grey Scale (GS) and power Doppler (PD) at 11 joints, extensor and flexor tendons in both hands. Patients were seen at 6 and 12 months. Treatment tapering was defined as dose reduction or discontinuation of any DMARD or corticosteroids. Flare within 12 months was defined as increase in DAS28 ≥1.2 or ≥0.6 if final DAS28>3.2. The relationship between the presence of GS-T/-S, PD-T/-S and flare was tested by logistic regression models, presented as odds ratios (OR) and 95% confidence interval (CI), adjusted for pre-specified confounders (age, sex, disease duration, comorbidities, rheumatoid factor, synthetic or biologic DMARDs, corticosteroids or NSAIDs). The models were applied to the whole population and separately in subgroups of patients in which treatment was or was not reduced.

Results:

361 patients were included, in 161 treatment was tapered [72. % F, mean age (sd) 56.1 (13.3) years, mean disease duration (sd) 9.75 (8.07) years]. 98/361 patients had a flare within 12 months, 48/154 among those tapering treatment. Considering US variables separately, only PD-S significantly predicted flare both in the whole population and in patients tapering treatment, but not in patients on stable treatment. When the model included both T and S, only the concurrent presence of T and S predicted flare [PD-T+-S: OR 2.06(1.04, 4.07)] in the overall population, while isolated S and T did not. The predictive value of PD-T+-S was not confirmed in patients in stable treatment, while it was enhanced in patients tapering treatment [OR 3.16(1.18,8.45)]. In the whole population GS-T+GS-S led to an increased risk of flare [OR 2.27, (1.01,5.10)], but this was not confirmed in the subgroups (Table 1).

Conclusion:

In patients with RA in clinical remission PD-T and PD-S predict subsequent disease flare, especially if treatment is tapered down. In addition to clinical evaluation, US could provide helpful information to drive treatment strategies in patients in clinical remission.

US abnormality	Overall population		Stable treatment		Tapering treatment
US abnormality	Crude OR (95% CI)	Adj OR (95%CI)	Crude OR (95% CI)	Adj OR (95%CI)	Crude OR (95% CI)	Adj OR (95%CI)
GS-T	1.59 (0.53,4.72)	1.53 (0.47,4.92)	1.87 (0.47,7.36)	1.73 (0.34,7.77)	1.22 (0.18,7.89)	1.40 (0.18,10.50)
GS-S	2.18 (0.97,4.92)	1.93 (0.81,4.57)	2.0 (0.65,6.10)	1.77 (0.50,6.19)	2.37 (0.70,8.02)	2.22 (0.61,8.02)
GS-T+-S	*2.88 (1.34,6.14)*	*2.27 (1.01,5.10)*	2.29 (0.84,6.22)	1.64 (0.53,5.01)	*3.76 (1.16,12.20)*	3.42 (0.98,11.92)
PD-T	0.59 (0.16,2.15)	0.47 (0.12,1.79)	0.34 (0.04,2.86)	0.34 (0.03,3.04)	1.31 (0.23,7.41)	0.82 (0.12,5.42)
PD-S	1.64 (0.93,2.90)	1.56 (0.85,2.85)	1.78 (0.80,3.95)	1.48 (0.61,3.58)	1.54 (0.68,3.50)	1.56 (0.64,3.76)
PD-T+-S	*2.75 (1.45,5.20)*	*2.06 (1.04,4.07)*	2.31 (0.95,5.64)	1.58 (0.58,4.32)	*3.54 (1.40,8.98)*	*3.16 (1.18,8.45)*

Table 1. Logistic regression models analyzing the predictive role of US findings over disease flare. OR: Odds Ratio, 95% CI: 95% confidence interval; GS: grey scale; PD: power Doppler; T: tenosynovitis; S: synovitis

Disclosure: A. Adinolfi, None; G. Cagnotto, None; F. Luccioli, None; C. Mastaglio, None; G. Mirabelli, None; D. Rossi, None; S. Rossi, None; E. Bellis, None; G. Carrara, None; C. A. Scirè, None; A. Iagnocco, None; G. Sakellariou, None.

To cite this abstract in AMA style:

Adinolfi A, Cagnotto G, Luccioli F, Mastaglio C, Mirabelli G, Rossi D, Rossi S, Bellis E, Carrara G, Scirè CA, Iagnocco A, Sakellariou G. In Patients with Rheumatoid Arthritis in Clinical Remission Undergoing Treatment Tapering Tenosynovitis and Synovitis Detected By Ultrasonography Predict Disease Flare [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/in-patients-with-rheumatoid-arthritis-in-clinical-remission-undergoing-treatment-tapering-tenosynovitis-and-synovitis-detected-by-ultrasonography-predict-disease-flare/. Accessed .

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