ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 134

Synovitis Assessed By the German 7-Joint Ultrasound Score (US7S) Is Associated with the Reversible Activity-Related Component of Physical Disability in Patients with Rheumatoid Arthritis 

Jakub Zavada1, Petra Hanova1, Jana Hurnakova1, Lenka Szczukova2, Michal Uher2, Šárka Forejtová1, Martin Klein1, Heřman F Mann1, Marta Olejarova1, Olga Sleglova1, Olga Ruzickova1 and Karel Pavelka1, 1Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic, 2Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Brno, Czech Republic

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: Restoring normal functioning is a major therapeutic aim. Differences in the sources of functional limitations should be considered in the interpretation of functional measures. We investigated the longitudinal relationship between HAQ and 7-joint ultrasound score (US7S1) in a prospective cohort of patients with RA.

Methods:   A cohort of 185 RA pts (46 incident/139 prevalent, mean±SD age 55±14 years, 47% RF+, 63% ACPA+, baseline DAS28-CRP 3.7±1.5, HAQ 0.78±0.73, disease duration incident vs. prevalent pts. 0.9±0.7 vs. 8.1± 8.3 resp.) was followed up for 29±9 months.  Assessments at baseline and then annually comprised DAS28-CRP, HAQ and US7S1. US7S includes 7 joints of the clinically dominant hand and foot and consists of 5 sub-scores for synovitis (syn) and tenosynovitis (ten) assessed by grey-scale (GS) and Power-Doppler (PD), and an erosions score (ES). A linear mixed model was used to assess the longitudinal relationship between US7 sub-scores and HAQ.  We used current and time-lag models to explore the association between HAQ and predictors measured at the same time or at the previous visit 12 month ago, resp. 

Results: Current model: In univariate analyses (table 1) HAQ was positively associated with GSsyn, PDsyn, PDten and GSten US7 sub-scores with resp. β coefficients significantly higher in incident than in prevalent patients. In a multivariate analysis (table 2) the US7 sub-scores were individually no longer significant predictors of HAQ, although the R2 of the model was improved by addition of US7 items from 37.4 to 48.7 (p<0.001 for improvement of R2). Time-lag model: In multivariate analyses (table 3) after adjustment for previous DAS28 and/or previous HAQ, both previous PDsynUS and GSsynUS were significantly and inversely associated with the current HAQ (table 3).

Conclusion: US7S subscores for synovitis were associated with the reversible activity-related component of HAQ, and may help to identify patients with higher chance for functional improvement. References:  1Backhaus M. et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009 Sep 15;61(9):1194-201 Acknowledgements:  This work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organization 023728.

Table 1 Current model. Univariate analyses and interaction with incident(i) /prevalent(p) RA. Predicted variable – current HAQ, univariate predictors current DAS28-CRP, GS and PD synovitis and tenosynovitis.
Predictor

RA

β (95% CI)

p-value*

p-value**

% variability explained – R2

DAS28-CRP

all

0.193 (0.165; 0.221)

<0.001

42.9

i

0.235 (0.177; 0.292)

<0.001

0.097

p

0.179 (0.147; 0.211)

<0.001

GSsynUS

all

0.019 (0.012; 0.027)

<0.001

4.5

i

0.037 (0.022; 0.052)

<0.001

0.011

p

0.014 (0.006; 0.023)

0.001

PDsynUS

all

0.027 (0.017; 0.036)

<0.001

5.2

i

0.041 (0.024; 0.058)

<0.001

0.039

p

0.020 (0.008; 0.031)

0.001

GStenUS

all

0.062 (0.021; 0.102)

0.003

2.6

i

0.135 (0.054; 0.217)

0.001

0.042

p

0.038 (-0.008; 0.084)

0.109

PDtenUS

all

0.057 (0.028; 0.086)

<0.001

3.2

i

0.111 (0.051; 0.170)

< 0.001

0.044

p

0.041 (0.009; 0.073)

0.013

ES

all

0.016 (-0.011; 0.043)

0.253

1.1

i

-0.021 (-0.100; 0.057)

0.597

0.321

p

0.021 (-0.008; 0.051)

0.152

* p-value of significance of given β. ** p-value of significance of difference between incident and prevalent RA.

Table 2 Current model. Multivariate analyses; predicted variable – HAQ, comparison of models based on demographic, clinical and immunological parameters with or without US7 subscales.

Model without US-7

Model with US-7

Predictor

β (95% CI)

p-value

β (95% CI)

p-value

Female

0.210 (0.054; 0.367)

0.008

0.215 (0.060; 0.371)

0.007

Age (years)

0.147 (0.100; 0.195)

< 0.001

0.145 (0.097; 0.193)

< 0.001

BMI

0.016 (0.002; 0.030)

0.029

0.015 (0.001; 0.029)

0.035

RF+ or ACPA+

0.046 (-0.089; 0.181)

0.501

0.037 (-0.098; 0.173)

0.589

Prevalent vs. incident RA

-0.018 (-0.170; 0.134)

0.821

0.019 (-0.154; 0.192)

0.829

DAS28-CRP

0.190 (0.163; 0.218)

< 0.001

0.204 (0.170; 0.238)

< 0.001

GSsynUS

–

0.005 (-0.019; 0.029)

0.670

PDsynUS

–

0.003 (-0.023; 0.029)

0.827

GStenUS

–

-0.040 (-0.162; 0.082)

0.519

PDtenUS

–

0.018 (-0.073; 0.110)

0.694

Erosions score

–

-0.038 (-0.111; 0.035)

0.306

R2 (% variability explained)

37.4

48.7

Improved R2

–

11.3

< 0.001*

* p-value of significance for improvement of prediction

 

Table 3 Time-lag model.  Multivariate analyses using either previous HAQ or DAS28 or both, and previous PDsynUS or GSsynUS (previous = measured 12 months ago) to predict current HAQ.

Analysis No

Predictor

β (95% CI)

p-value

% variability explained by the model  (R2)

1

Previous HAQ

0.773 (0.709; 0.837)

< 0.001

65.3

Previous PDsynUS

-0.016 (-0.026; -0.005)

0.003

2

Previous PDsynUS

-0.025 (-0.039; -0.011)

0.001

33.7

Previous DAS28

0.164 (0.116; 0.212)

< 0.001

3

Previous HAQ

0.711 (0.628; 0.794)

< 0.001

65.9

Previous PDsynUS

-0.022 (-0.033; -0.010)

< 0.001

Previous DAS28

0.053 (0.008; 0.098)

0.022

4

Previous HAQ

0.764 (0.700; 0.828)

< 0.001

64.8

Previous GSsynUS

-0.009 (-0.017; -0.001)

0.032

5

Previous  GSsynUS

-0.012 (-0.023; -0.001)

0.028

33.6

Previous DAS28

0.146 (0.098; 0.194)

< 0.001

6

Previous HAQ

0.713 (0.629; 0.797)

< 0.001

65.2

Previous GSUS_syn

-0.012 (-0.021; -0.003)

0.006

Previous DAS28

0.042 (-0.004; 0.088)

0.071

Disclosure: J. Zavada, None; P. Hanova, None; J. Hurnakova, None; L. Szczukova, None; M. Uher, None; Š. Forejtová, None; M. Klein, None; H. F. Mann, None; M. Olejarova, None; O. Sleglova, None; O. Ruzickova, None; K. Pavelka, None.

To cite this abstract in AMA style:

Zavada J, Hanova P, Hurnakova J, Szczukova L, Uher M, Forejtová Š, Klein M, Mann HF, Olejarova M, Sleglova O, Ruzickova O, Pavelka K. Synovitis Assessed By the German 7-Joint Ultrasound Score (US7S) Is Associated with the Reversible Activity-Related Component of Physical Disability in Patients with Rheumatoid Arthritis  [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/synovitis-assessed-by-the-german-7-joint-ultrasound-score-us7s-is-associated-with-the-reversible-activity-related-component-of-physical-disability-in-patients-with-rheumatoid-arthritis/. Accessed .

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/synovitis-assessed-by-the-german-7-joint-ultrasound-score-us7s-is-associated-with-the-reversible-activity-related-component-of-physical-disability-in-patients-with-rheumatoid-arthritis/