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Abstract Number: 107

Sensitivity to Change of the Ultrasound synovitis  SONAR Score in RA Patients : Results of  the Scqm Cohort

Pascal Zufferey1, Almut Scherer2, Hans Rudolf Ziswiler3, Giorgio Tamborrini4, Laure Brulhart5 and Burkhard Moeller6, 1Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland, 2SCQM Foundation, Zurich, Switzerland, 3Rheumatology, Clinical Immunology and Allergology, Inselspital, University of Bern, Bern, Switzerland, 4Department of Rheumatology, University Hospital, Zurich, Switzerland, 5service de Rhumatologie, Geneva, Switzerland, 6Rheumatology & Clin Immunology, Inselspital Bern, Bern, Switzerland

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Decision analysis, Doppler ultrasound, rheumatoid arthritis (RA) and ultrasound

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Session Information

Title: Imaging of Rheumatic Diseases: Ultrasound, Nuclear Medicine and Fluorescence Imaging

Session Type: Abstract Submissions (ACR)

Background/Purpose: Since the end of 2009, an ultrasound scoring call SONAR has been implemented for RA patients as a routine tool in the SCQM registry (Swiss Clinical Quality Management registry for rheumatic diseases). A cross-sectional evaluation of patients with active disease and clinical remission according to the DAS28ESR and the novel ACR/EULAR remission criteria from 2010 clearly indicated a good correlational external validity of synovial pathologies with clinical disease activity in RA (2012 EULAR meeting

The objective: of this study was to evaluate the sensitivity to change of B-mode and Power-Doppler scores in a longitudinal perspective along with the changes in DAS28ESR in two consecutive visits among the patients included in the SCQM registry

Methods: All patients who had at least two SONAR scores and simultaneous DAS28ESR evaluations between December 2009 and June 2012 were included in this study. The data came from 20 different operators working mostly in hospitals but also in private practices, who had received a previous teaching over 3 days in a reference center. The SONAR score includes a semi-quantitative B mode and Power-Doppler evaluation of 22 joints from 0 to 3, maximum 66 points for each score. The selection of these 22 joints was done in analogy to a 28 joint count and further restricted to joint regions with published standard ultrasound images. Both elbows and wrist joints were dynamically scanned from the dorsal and the knee joints from a longitudinal suprapatellar view in flexion and in joint extension. The bilateral evaluation of the second to fifth metacarpophalangeal and proximal interphalangeal joints was done from a palmar view in full extension, and the Power-Doppler scoring from a dorsal view with hand and finger position in best relaxation

Results: From the 657 RA patients with at least one score performed, 128 RA patients with 2 or more consultations of DAS28ESR, and a complete SONAR data set could be included. The mean (SD) time between the two evaluations was  9.6 months (54). The mean (SD) DAS28ESR was: 3.5 (1.3) at the first visit and was significantly lower (mean 3.0, SD.2.0, p:<0.0001) at the second visit. The mean (SD) of the total B mode was 12 (9.5) at baseline and 9.6 (7.6) at follow-up (p=0.0004). The Power-Doppler score at entry was 2.9 (5.7) and 1.9 (3.6),  at the second visit, p <0.0001

The Pearson r correlation between change in DAS28ESR and the B mode was 0.44 (95% CI: 0.29, 0.57, p < 0.0001),and 0.35 (95% CI: 0.16, 0.50, p = 0.0002) for the Power-Doppler score,. Clinical relevant change in DAS (>1.1) was associated with a change of total B mode  score >3  in  23/32 patients and a change a Doppler score >0.5 in 19/26

Conclusion: This study confirms that the SONAR score  is sensitive to change and provides a complementary method  of assessing RA disease activity to the DAS  that could be very useful in daily practice.

.


Disclosure:

P. Zufferey,
None;

A. Scherer,
None;

H. R. Ziswiler,
None;

G. Tamborrini,
None;

L. Brulhart,
None;

B. Moeller,
None.

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