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Abstract Number: 2652

Power Doppler Ultrasound Features in Rheumatoid Arthritis Patients in Clinical Remission: Reclassifying Disease Activity?

Facundo Vergara1, Santiago Ruta1, Maria de los Angeles Gallardo1, Emmanuel Bertiller2, Josefina Marin1, Javier Rosa3, Ricardo Garcia-Monaco4 and Enrique R. Soriano5, 1Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 2Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Argentina, 3Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 4Radiology and Imagenology Department, Hospital italiano de Buenos Aires, Buenos Aires, Argentina, 5Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Doppler ultrasound, remission and rheumatoid arthritis (RA)

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Session Information

Date: Tuesday, November 10, 2015

Session Title: Rheumatoid Arthritis - Clinical Aspects Poster Session III

Session Type: ACR Poster Session C

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

Background/Purpose: Many studies have shown disparity between clinical and ultrasound (US) findings in rheumatoid arthritis (RA). US appears to detect subclinical synovitis in patients in clinical remission. The aim of the present study was to compare clinical and US activity in patients with RA in clinical remission, applying different US definitions of an active joint, and to evaluate whether replacing clinical by US assessment would change patients’ disease activity state.

Methods: We included consecutive patients with RA according to 2010 ACR/EULAR criteria in clinical remission by DAS28 (<2.6). US examinations were performed by the same rheumatologist, using a MyLab 70 machine equipped with 6-18 MHz broad band multi-frequency linear transducer. The following 20 joints of both hands were assessed: wrist, first to fifth MCP joints and second to fifth proximal PIP joints. Power Doppler (PD) US signal was evaluated on a semi-quantitative scale from 0 to 3 (0= no PD signal; 1= a single PD signal; 2= confluent PD signal in less than 50% of intra-articular area; 3= PD signal in more than 50% of intra-articular area). Three different US DAS28 (US DAS28) were constructed, replacing the clinical swollen joint count by the PD US joint count (clinical examination was used for joints not included in US assessment) using PD grade ≥ 1, ≥ 2 or ≥ 3, respectively.

Results: Eighty six patients were included. Sixty-five (75.5%) were female; mean age (SD) was 58.5 (13.8) years; and mean disease duration (SD) was 7.2 (7.9) years. Mean DAS28 (SD) was 2.1 (0.37). Twenty-three (26.7%) patients had at least one joint with abnormal vascularization by PD US (PD ≥ 1). Among these, 14 (60.8%) had only one joint with abnormal vascularization by PD ≥ 1; 6 (26.1%) had two; 2 (8.7%) had three and 1 (4.3%) had four. Mean (SD) US DAS28 were 2.18 (0.47); 2.16 (0.45) and 2.1 (0.4) using the number of joints with PD grade ≥ 1; ≥2 and ≥3, respectively. Thirteen out of 86 (15%) patients were reclassified to low disease activity using US DAS28 with PD ≥ 1. Using US DAS28 with PD ≥ 2, only nine (10.5%) patients were reclassified to low disease activity, and US DAS28 with PD ≥ 3 did not reclassify any patient. No patients were reclassified into moderate or high disease activity using any of PD grades (Table). Correlation between clinical DAS28 and US DAS28 was excellent (Spearman’s rho: 0.8271; 0.8470 and 0.8701 for US DAS28 using PDUS grade ≥ 1; ≥ 2 and ≥3, respectively).

Table. Clinical and US DAS28 scores in patients with at least one joint with PD signal. 

 

Clinical DAS28

Number of joints with PD Grade 1

Number of joints with PD

Grade 2

Number of joints with PD

Grade 3

US DAS28 with PD

grade ≥ 1

US DAS28 with PD

grade ≥ 2

US DAS28 with PD

grade ≥ 3

1

2,36

0

1

0

2,64

2,64

2,36

2

1,64

0

0

1

1,64

1,64

1,64

3

2,44

0

1

0

2,72

2,72

2,44

4

2,17

0

2

0

2,57

2,57

2,17

5

2,52

0

3

0

2,72

2,72

2,52

6

2,5

1

0

0

2,78

2,5

2,5

7

2,42

0

3

0

2,91

2,91

2,42

8

2,06

0

1

0

2,34

2,34

2,06

9

2,38

1

0

0

2,66

2,38

2,38

10

2,57

1

0

0

2,85

2,57

2,57

11

2,52

1

0

0

2,8

2,52

2,52

12

2,43

3

1

0

2,99

2,71

2,43

13

2,57

0

2

0

2,96

2,96

2,57

14

1,64

0

1

1

2,04

2,04

1,92

15

2,59

0

1

0

2,59

2,59

2,31

16

2,24

0

2

0

2,63

2,63

2,24

17

2,34

1

1

0

2,74

2,62

2,34

18

1,25

0

1

0

1,53

1,53

1,25

19

2,31

0

1

0

2,59

2,59

2,31

20

2,08

0

1

0

2,36

2,36

2,08

21

2,06

0

1

0

2,34

2,34

2,06

22

0,4

1

1

0

0,4

0,28

0,0

23

2,5

0

1

0

2,78

2,78

2,5

PGA: patient global assessment; ESR: erythrosedimentation rate. 

 

Conclusion: Although around one quarter of patients with RA in clinical remission showed PD US features indicating residual activity, a low percentage of these patients were reclassified to a DAS28 low disease activity state, and none to either moderate or high disease activity, using PD US assessment. There was a very good correlation between clinical and US assessment.


Disclosure: F. Vergara, None; S. Ruta, None; M. D. L. A. Gallardo, None; E. Bertiller, None; J. Marin, None; J. Rosa, None; R. Garcia-Monaco, None; E. R. Soriano, Abbvie; Janssen; UCB; Roche; Bristol Myers Squibb, 2,Abbvie; UCB; Janssen; Roche; Bristol Myers Squibb; Pfizer; Novartis, 8.

To cite this abstract in AMA style:

Vergara F, Ruta S, Gallardo MDLA, Bertiller E, Marin J, Rosa J, Garcia-Monaco R, Soriano ER. Power Doppler Ultrasound Features in Rheumatoid Arthritis Patients in Clinical Remission: Reclassifying Disease Activity? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/power-doppler-ultrasound-features-in-rheumatoid-arthritis-patients-in-clinical-remission-reclassifying-disease-activity/. Accessed February 28, 2021.
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