Optimization of Ultrasonographic Examination for the Diagnosis of Erosive Rheumatoid Arthritis Versus Erosive Osteoarthritis with Radiography Considered As Gold Standard

Camille Roux¹, Frédérique Gandjbakhch², Audrey Pierreisnard³, Marion Couderc⁴, Cédric Lukas⁵, Racha Masri¹, Jean-Philippe Sommier¹, Isabelle Clerc-Urmès⁶, Cedric Baumann⁷, Isabelle Chary-Valckenaere⁸ and Damien Loeuille¹, ¹Rheumatology, CHRU Nancy, Vandoeuvre les Nancy, France, ²UPMC University Paris 06, Pitié-Salpétrière Hospital, Paris, France, ³APHP, Paris, France, ⁴Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France, ⁵Rheumatology, CHU Lapeyronie and EA2415, Montpellier University, University of Montpellier, France, ⁶CHRU Nancy, Nancy, France, ⁷CHRU Nancy, Vandoeuvre les Nancy, France, ⁸Rheumatology, CHRU Nancy, Vandoeuvres les Nancy, France

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: diagnosis, Osteoarthritis, radiography, rheumatoid arthritis (RA) and ultrasonography

Session Information

Date: Monday, October 22, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster II: Diagnosis and Prognosis

Session Type: ACR Poster Session B

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

Background/Purpose: Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory joint disease (1,2) responsible for structural damage. Radiography (RX) is considered as the gold standard for visualizing and quantifying bone lesions in RA (3). Musculoskeletal ultrasound (US) is booming in clinical practice for the diagnosis of RA. US can detect more erosions than RX at the joint level, especially at an early stage of the disease. (4) The Objectives are to determine thresholds and better scenarios for the diagnosis of erosive RA by US in RA and osteoarthritic (OA) patients.

Methods: Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or hand OA criteria were prospectively included. A modified Sharp erosion score was assessed by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Erosions in US were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale.

Results: A total of 168 patients were included: 122 RA (32 early RA <2 years; 90 late RA ≥2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients were eroded according to ACR/EULAR 2013 criteria (sensitivity: 34.4%, specificity: 89.1%). On US, 95 RA patients (21 early; 78 late) and 12 OA patients were eroded. Considering at least two joint facets eroded (threshold 1) or at least one joint facet eroded at grade 2 (threshold 2), sensitivities were good (68-72.1%) and specificities excellent (89.1-100%). With only six targeted joint facets examined, 73 and 74 patients were classified as erosive RA with threshold 1 and 2 with good sensitivities (59.8-60.0%) and excellent specificities (95.6-100%) respectively. For all scenarios, agreement between RX and US for the diagnosis of erosive RA was excellent (88.1% to 92.8%).

Conclusion: US erosion assessment of six targeted joint facets permitted to detect 1.7 times more erosive RA patients than RX in late and early RA.

References :

1- Guillemin F, Saraux A, Guggenbuhl P, Roux CH, Fardellone P, Le Bihan E, et al. Prevalence of rheumatoid arthritis in France: 2001. Ann Rheum Dis. 2005 Oct;64(10):1427–30.

2- Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum. 2006 Dec;36(3):182–8

3- Baillet A, Gaujoux-Viala C, Mouterde G, Pham T, Tebib J, Saraux A, et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatol Oxf Engl. 2011 Jun;50(6):1137–47.

4- Wakefield RJ, Gibbon WW, Conaghan PG, O’Connor P, McGonagle D, Pease C, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 2000 Dec;43(12):2762–70.

Disclosure: C. Roux, None; F. Gandjbakhch, None; A. Pierreisnard, None; M. Couderc, None; C. Lukas, None; R. Masri, None; J. P. Sommier, None; I. Clerc-Urmès, None; C. Baumann, None; I. Chary-Valckenaere, None; D. Loeuille, None.

To cite this abstract in AMA style:

Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, Sommier JP, Clerc-Urmès I, Baumann C, Chary-Valckenaere I, Loeuille D. Optimization of Ultrasonographic Examination for the Diagnosis of Erosive Rheumatoid Arthritis Versus Erosive Osteoarthritis with Radiography Considered As Gold Standard [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/optimization-of-ultrasonographic-examination-for-the-diagnosis-of-erosive-rheumatoid-arthritis-versus-erosive-osteoarthritis-with-radiography-considered-as-gold-standard/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/optimization-of-ultrasonographic-examination-for-the-diagnosis-of-erosive-rheumatoid-arthritis-versus-erosive-osteoarthritis-with-radiography-considered-as-gold-standard/