Session Title: Imaging of Rheumatic Diseases: Ultrasound
Session Type: Abstract Submissions (ACR)
Background/Purpose: To evaluate if the 7-joint ultrasound scoring system (US7) is able to find synovitis in patients in remission of RA.
Methods: Patients with rheumatoid arthritis (RA) in the state of remission according to DAS 28 < 2,6 criteria with duration at least 3 months were identified. HAQ, SJC, TJC were evaluated for 1 year in 3 months interval. The US7 was assessed by every visit. US7 scoring system was well described and uses semiquantitative assessment of grey scale (GS) and power-doppler (PD) synovitis and incorporates erosion count together with evaluation of soft tissue parts (tenosynovitis) on the dominant hand and foot. Participating sonographers were blinded to clinical assesments and used the same US machine with not changed settings during the study follow up and reached reasonable interobserver and intraobserver reliability in using US7 scoring system. Spearmann coefficient was used to calculate statistical correlations.
Results: 73 patients were registered, 212 patient visits were made and 1484 joints were investigated. 13 patients (17,3%) in clinical remission according to DAS28<2,6 had no synovitis in US7 (GS0, PD0), only tenosynovitis was present in 3 patients (4,1%). 62 patients (82,7%) had subclinical synovitis in US7 at the baseline (GS/PD>0). In 34 patients (46%) PD ≥2 was found. Relapse rate during one-year observation (DAS28>2,6) was 17% both in 3rd and 6th months, 9% in 9th month and 18% in 12thmonth. Total score of GS and PD synovitis on US7 significantly correlated with DAS28 and SDAI in months 3,6 and 12 (all p<0,01). This statistical significance was not reached at baseline and in month 9 with relapse rates of 0 and 9% respectively, thus only subclinical synovitis was more frequently seen while DAS28<2,6. There was observed a strong correlation between presence of synovitis and tenosynovitis (TS) on US7 (p<0,01) but no correlation of TS itself and other disease activity was found (DAS28, SDAI, HAQ, CRP). Number of erosions increased during one-year observation.
Conclusion: It was possible to find a high percentage of subclinical synovitis in patients in remission of RA according to previous studies published using other scoring systems. PD signals were in majority of investigations absent or very low (0 or 1), what is in good correlation with data published. There was no statistical difference in disease activity found in US7 score between patients with DMARDs and biological therapy in our sample. US7 may be a simple and effective tool to evaluate the disease activity of RA not only in active disease but also in the state of remission in daily clinical practice. Other studies are needed to confirm these findings with US7.
Supported by the project (Ministry of Health, Czech Republic) for conceptual development of research organization 023728 (Institute of Rheumatology) and by project No. NT12437.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/seven-joints-ultrasound-scoring-system-may-be-useful-and-effective-in-assessing-disease-activity-in-patients-with-rheumatoid-arthritis-in-the-state-of-remission-in-daily-clinical-practice/