ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 140

Relationship Between the Prevalence of Subclinical Tenosynovitis and Therapy in Patients with RA in Clinical Remission: Results from Italian Society of Rheumatology Study Group

Simone Parisi1, Greta Carrara2, Carlo Alberto Scirè3,4, Alberto Batticciotto5, Emanuela Bellis6, Marco Canzoni7, Orazio De Lucia8, Ilaria Farina9, Carlo Venditti10, Annamaria Iagnocco11,12 and Georgios Filippou13, 1Department of Rheumatology, University Hospital Città Della Salute e della Scienza di Torino, Turin, Italy, 2Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy, 3Epidemiology Unit -Italian Society for Rheumatology, Milano, Italy, 4Epidemiology Unit – Italian Society for Rheumatology (SIR), Milano, Italy, 5Rheumatology, L. Sacco University Hospital, Milano, Italy, 6Rheumatology, Ospedale Mauriziano, Turin, Italy, 7A.O. Sant'Andrea, Rome, Italy, 8Rheumatology, Orthopedic Institute Gaetano Pini, Milano, Italy, 9Rheumatology Unit AOU S.Anna, Ferrara, Italy, 10A.O. Rummo, Benevento, Italy, 11Sapienza University of Rome, Rome, Italy, 12Sapienza University of Rome, Italy, Roma, Italy, 13University of Siena, Siena, Italy

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: , , , ,

Session Information

Date: Sunday, November 13, 2016

Title: Imaging of Rheumatic Diseases - Poster I: Ultrasound and Emerging Technologies

Session Type: ACR Poster Session A

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

Background/Purpose: This study is a sub-analysis of the data from the patient cohort of STARTER (The Sonographic Tenosynovitis Assessment in RheumaToid arthritis patiEnts in Remission) study group conducted by the Musculoskeletal Ultrasound Study Group of the Italian Society for Rheumatology (SIR). In this study we have proved the association between prevalence of ultrasound tenosynovitis in patients with RA in remission and increased risk of flare in one year. The aim of this ancillary study was to evaluate if the patients in combo therapy with DMARDs and Biologic present lower ultrasound joint and/or tendon involvement in compare to patients treated with only DMARDs or Biologic in monotherapy.

Methods : STARTER is a multicentre cohort study promoted by the Musculoskeletal Ultrasound Study Group of SIR that includes 25 Italian rheumatology units. 427 consecutive patients with a diagnosis of RA according to the American College of Rheumatology (ACR) criteria 1987 or ACR/EULAR (European League Against Rheumatism) 2010 criteria and in clinical remission were recruited between October 2013 and June 2014; at baseline (T0), 6 (T1) and 12 (T2) months each patient was undergoing clinical evaluation (performed by rheumatologists blinded to the ultrasound data) and ultrasound by using a semi-quantitative score 0-3 gray scale (GS) and power doppler (PD) for the evaluation of the flexor and extensor tendons of the fingers and wrists. For each patient it was calculated a final score of GS-tenosynovitis, PD-tenosynovitis. The ultrasound remission was defined as a score = 0. Were included in the study 427 patients, divided into 3 subgroups according to background therapy at baseline: patients with biologic in monotherapy (BIO), patients with DMARD in monotherapy (DMARDs), patients in combo therapy (DMARDs + BIO).

Results : 257 patients completed the observation period. 49 pts in BIO group (19.7%, F34 / M15), 152 pts in the DMARDs group (59.14% -F105 / M47), 56 pts in BIO + DMARDs group (21.79% -F47 / M9). The demographic and clinical characteristics at baseline are presented in Table 1 and 2. At baseline, 56.03% (144/257) of patients showed tenosynovitis, the 48.98% (24/49) BIO, the 57.89% (88/152) DMARDs, the 57.14% (32/56) DMARDs + BIO. The tenosynovitis involvement at baseline, at 6 and 12 months showed into three different subgroups analyzed, has no statistically significant changes (Fig. A). In the BIO group, there was a patient who had a flare few days prior to follow up visit at T12.

Conclusion : As shown in STARTER study, the prevalence of subclinical tenosynovitis is relevant in the subpopulation of patients with RA in clinical remission. The analysis into subgroups, based on the therapy performed, although it did not show any significant differences, demonstrated a trend to a lower prevalence of inflammatory manifestations of the tendons of the hands and wrists in favor of patients with combo therapy (DMARDs + BIO ) than patients with only DMARDs o Biological in monotherapy. These results could indicate a higher probability to getting better outcomes in patients treated by combo therapy.

GROUP (257)

AGE

(m±SD)

BMI

(m±SD)

Durata Malattia

(M-IQR)

Durata Remissione

(M-IQR)

Steroids

(Y/N)

NSAID

(N/Y)

RF

(-/+)

Anti-CCP

(-/+)

BIO (49)

54.63±13.4

24.59±3.6

12.27 (9.1-17.9)

16 (10-30)

27/22

21/28

18/31

23/26

DMARDs (152)

57.59±13.6

24.67±4.3

4.92 (2.29-9.35)

12 (6-24)

78/74

75/77

77/75

71/80

DMARDs+BIO (56)

55.36±11.8

24.70±4.1

8.06 (5.7-14.7)

14 (9.5-24)

35/21

26/30

23/33

20/03/16

GROUP

(257)

Flare Questionnaire

(M-IQR)

HAQ

(M-IQR)

DAS28

(m±SD)

CDAI

(m±SD)

SDAI

(m±SD)

BIO

(49)

5 (0-20)

0.250 (0-0.625)

1.97±0.7

3.04±3.3

4.03±6.7

DMARDs

(152)

2 (0-10)

0 (0-0.250)

2.07±0.7

2.07±2.1

2.24±2.1

DMARDs+BIO (56)

1 (0-7.5)

0.062 (0-0.250)

1.86±0.7

1.60±1.8

1.94±1.9

DMARDs+BIO (56)

1 (0-7.5)

0.062 (0-0.250)

1.86±0.7

1.60±1.8

1.94±1.9

Tab.1 Demographic and therapeutic characteristics at baseline into 3 subgroups Tab.2 Clinimetric characteristics at baseline into 3 subgroups

Tenosynovitis

Casella di testo: Tenosynovitis

Fig.A

Disclosure: S. Parisi, None; G. Carrara, None; C. A. Scirè, None; A. Batticciotto, None; E. Bellis, None; M. Canzoni, None; O. De Lucia, None; I. Farina, None; C. Venditti, None; A. Iagnocco, None; G. Filippou, None.

To cite this abstract in AMA style:

Parisi S, Carrara G, Scirè CA, Batticciotto A, Bellis E, Canzoni M, De Lucia O, Farina I, Venditti C, Iagnocco A, Filippou G. Relationship Between the Prevalence of Subclinical Tenosynovitis and Therapy in Patients with RA in Clinical Remission: Results from Italian Society of Rheumatology Study Group [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/relationship-between-the-prevalence-of-subclinical-tenosynovitis-and-therapy-in-patients-with-ra-in-clinical-remission-results-from-italian-society-of-rheumatology-study-group/. Accessed .

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