No Clear Association Between the Presence of Ultrasound Synovitis and Patient Reported Outcomes in Rheumatoid Arthritis Patients in Remission

Myrthe van der Ven¹, T. Martijn Kuijper¹, Andreas Gerards², I. Tchetverikov³, A.E.a.M. Weel^1,4, Derkjen van Zeben⁵, Mieke Hazes¹ and J.J. Luime¹, ¹Rheumatology, Erasmus University Medical Center, Rotterdam, Netherlands, ²Rheumatology, Vlietland Hospital, Schiedam, Netherlands, ³Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands, ⁴Department of Rheumatology, Maasstad Hospital, Rotterdam, Netherlands, ⁵Rheumatology, Sint Franciscus Gasthuis, Rotterdam, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: patient outcomes, remission, rheumatoid arthritis (RA) and ultrasound

Session Information

Date: Tuesday, November 10, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster Session III

Session Type: ACR Poster Session C

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

Background/Purpose: Several
studies assessed disease activity with ultrasound in rheumatoid arthritis (RA) patients
who were in clinical remission. These studies found ultrasound synovitis in 48-73%
of the patients. Ultrasound synovitis is associated predicts short-term relapse
in RA patients. So far, little is known about the association between ultrasound
synovitis and patient reported outcomes (PROs). Our first objective was to
evaluate the frequency of ultrasound synovitis in RA patients in clinical
remission while they are continuing synthetic and biological DMARDs. Our second
objective was to compare PROs between patients in clinical remission with and
without ultrasound synovitis.

Methods: RA
patients who are treated with the combination of a synthetic DMARD and biological
DMARD (adalimumab or etanercept) and have low disease activity (DAS44<2.4
and SJC ≤1) were examined by ultrasound at baseline and after three
months follow-up. Ultrasound examination included 26 joints (MCP2-5, PIP2-5,
wrists, MTP2-5) graded on greyscale (GS;0-3) and power Doppler (PD;0-3). A
joint with ultrasound synovitis was defined as GS>1 and/or PD>0. Data on
clinical and psychological characteristics, demographics, pain scores,
functional ability (HAQ) and health-related quality of life (SF-36) were collected
at baseline and at three months. Coping (Pain Coping and Cognition List [PCCL]),
depression/anxiety symptoms (Hospital Anxiety and Depression Scale[HADS]) and
fatigue (Bristol RA Fatigue Multi-Dimensional Questionnaire [BRAF-MDQ] and
Fatigue Assessment Scale [FAS]) were collected at three months follow-up. Ultrasound
synovitis positive and negative patients were compared on their PROs using the
Wilcoxon-Mann-Whitney test and Chi-square test.

Results: At
baseline, 89 RA patients were included of which 71 patients had had their three
months evaluation. Ultrasound revealed synovitis in 64% of the patients at
baseline and in 68% at three months. In 44% of the patients ultrasound synovitis
was detected at both measurements. Table 1 shows baseline characteristics and
patient reported outcomes at baseline and after three months. No clear pattern
emerged on the PROs scores between ultrasound synovitis positive and negative
patients. At baseline functional ability differed between the two groups while
health-related quality of life was similar. At three months similar levels were
observed for functional ability, health-related quality of life, coping,
depression symptoms and fatigue. HADS anxiety differed at 3 months.

Conclusion:
Ultrasound synovitis is common in RA patients in clinical remission while they
continue synthetic and biological DMARDs. In our study population we could not
find a clear association between ultrasound synovitis and PROs.

Table 1 Baseline characteristics and patient reported outcomes
Clinical and demographic characteristics (n=89)
Age, mean ±sd years	55 (12)
Women	66%
Time since diagnose, mean ±sd years	5 (3.4)
DAS44, mean ±sd	1.1 (0.5)
DAS44 remission (DAS44<1.6)	82%
BSE, median (IQR)	8 (3-16)
RF positive	55%
ACCP positive	69%

Patient reported outcomes	Visit 1			Visit 2
	US negative (n=35)	US positive (n=54)	p-value*	US negative (n=23)	US positive (n=48)	p-value*
HAQ (range 0-3), median (IQR)	0.3 (0-0.9)	0.6 (0.1-1.4)	0.029	0.3 (0-0.6)	0.3 (0-0.6)	0.928
SF36 (range 0-100), median (IQR)
PCS	49 (44-52)	44 (38-50)	0.084	48 (44-52)	46 (40-52)	0.780
MCS	54 (49-59)	57 (54-59)	0.134	55 (41-59)	58 (54-61)	0.054
HADS anxiety >7 (range 0-21)				24%	2%	0.004
HADS depression >7 (range 0-21)				14%	2%	0.056
BRAF (range 0-70), median (IQR)				21 (13-26)	14 (6-23)	0.070
Fatigue (FAS; range 10-50), median (IQR)				21 (18-23)	18 (14-23)	0.160
PCCL (range 1-6), median (IQR)				1.8 (1.3-2.5)	1.4 (1.1-2.4)	0.264
US = Ultrasound; HAQ = Health Assessment Questionnaire; SF-36 = Short Form 36; HADS = Hospital Anxiety and Depression Scale; BRAF = Bristol RA Fatigue Multi-Dimensional Questionnaire; FAS = Fatigue Assessment Scale; PCCL = Pain Coping and Cognition Scale; sd = standard deviation; IQR = interquartile range; *Wilcoxon-Mann-Whitney test for continuous scales, Chi-square test for binary scales

Disclosure: M. van der Ven, None; T. M. Kuijper, None; A. Gerards, None; I. Tchetverikov, None; A. E. A. M. Weel, None; D. van Zeben, None; M. Hazes, None; J. J. Luime, None.

To cite this abstract in AMA style:

van der Ven M, Kuijper TM, Gerards A, Tchetverikov I, Weel AEAM, van Zeben D, Hazes M, Luime JJ. No Clear Association Between the Presence of Ultrasound Synovitis and Patient Reported Outcomes in Rheumatoid Arthritis Patients in Remission [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/no-clear-association-between-the-presence-of-ultrasound-synovitis-and-patient-reported-outcomes-in-rheumatoid-arthritis-patients-in-remission/. Accessed .

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