The Discrepancy between the EULAR Response Criteria and Ultrasonography Assessment for Monitoring Therapeutic Response in Rheumatoid Arthritis

Ryusuke Yoshimi¹, Yuichiro Sato¹, Natsuki Sakurai¹, Takaaki Komiya¹, Naoki Hamada¹, Hideto Nagai¹, Naomi Tsuchida², Yumiko Sugiyama¹, Yutaro Soejima¹, Yosuke Kunishita¹, Hiroto Nakano¹, Daiga Kishimoto¹, Reikou Kamiyama¹, Kaoru Minegishi-Takase³, Yohei Kirino¹, Shigeru Ohno⁴ and Hideaki Nakajima¹, ¹Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan, ²Department of Hematology and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan, ³Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan, ⁴Center for Rheumatic Disease, Yokohama City University Medical Center, Yokohama, Japan

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: rheumatoid arthritis (RA) and ultrasonography

Session Information

Date: Sunday, November 5, 2017

Title: Imaging of Rheumatic Diseases Poster I

Session Type: ACR Poster Session A

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

Background/Purpose: Although the European League Against Rheumatism (EULAR) response criteria based on the Disease Activity Score (DAS) 28 has been widely used for assessment of treatment response in clinical trials for rheumatoid arthritis (RA), it is still unclear whether it is indeed reflected by the change of synovitis severity. Musculoskeletal ultrasonography (US) is now one of the standard tools for the diagnosis and monitoring of active synovitis. Here, we investigated the association between the EULAR response criteria and the US assessment in monitoring RA activity.

Methods: Power Doppler (PD) US was performed in 24 joints, including all PIP, MCP, bilateral wrist and knee joints, as comprehensive evaluation in 23 RA patients treated with certolizumab pegol (CZP; n = 15) or tofacitinib (TOF; n = 8). Before and after treatment with CZP or TOF, PD signals and gray-scale (GS) images were scored semiquantitatively from 0 to 3 in each joint. Total PD score-24 and total PD score-8 were calculated by summing up PD scores of the 24 joints and the selected 8 joints (bilateral second and third MCP, wrist, and knee joints), respectively. Total GS score-24 and total GS score-8 were also calculated by summing up GS scores of the 24 joints and the selected 8 joints, respectively.

Results: Among the 23 patients, no response was shown in 5, moderate response was in 12, and good response was in 6 patients by EULAR response criteria. The change of total PD score-24 by treatment with CZP or TOF was significantly different between the patients with no response and moderate response (1[interquartile range (-2)-(2)] vs -5[(-11)-(-1.75)], p = 0.012) or good response (1[(-2)-(2)] vs -8[(-9.75)-(-7)], p = 0.0043). The change of total PD score-8 was also significantly different between the patients with no response and moderate response (1[(-2)-(2)] vs -3.5[(-7.25)-(-1.75)], p = 0.012) or good response (1[(-2)-(2)] vs -6.5[(-7.75)-(-5.25)], p = 0.0022). The change of total GS score-24 and total GS score-8 were significantly different between the patients with no response and good response (-2[(-2)-(1)] vs -9[(-16.5)-(-4.5)], p = 0.011, and -1[(-1)-(-1)] vs -6[(-8)-(-4)], 0.0022, respectively). Among the patients with no response, 2 (40%) showed decrease in total PD score-24 and total PD score-8, and 3 (60%) and 4 (80%) showed decrease in total GS score-24 and total GS score-8, respectively. Among the patients with moderate response, 2 (17%) showed no improvement in total PD score-24 and total PD score-8, and 3 (25%) and 5 (42%) showed no improvement or even increase in total GS score-24 and total GS score-8, respectively. Thus total 4 (17%) and 6 (26%) showed discrepancy between EULAR response criteria and 24-joint US assessment.

Conclusion: Although this study indicates the relationship between EULAR response criteria and US assessment as a whole, there are some cases showing discrepancy between these two assessment methods in monitoring RA activity. Thus the US assessment can be an essential method for monitoring response to treatment in RA patients.

Disclosure: R. Yoshimi, None; Y. Sato, None; N. Sakurai, None; T. Komiya, None; N. Hamada, None; H. Nagai, None; N. Tsuchida, None; Y. Sugiyama, None; Y. Soejima, None; Y. Kunishita, None; H. Nakano, None; D. Kishimoto, None; R. Kamiyama, None; K. Minegishi-Takase, None; Y. Kirino, None; S. Ohno, None; H. Nakajima, None.

To cite this abstract in AMA style:

Yoshimi R, Sato Y, Sakurai N, Komiya T, Hamada N, Nagai H, Tsuchida N, Sugiyama Y, Soejima Y, Kunishita Y, Nakano H, Kishimoto D, Kamiyama R, Minegishi-Takase K, Kirino Y, Ohno S, Nakajima H. The Discrepancy between the EULAR Response Criteria and Ultrasonography Assessment for Monitoring Therapeutic Response in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-discrepancy-between-the-eular-response-criteria-and-ultrasonography-assessment-for-monitoring-therapeutic-response-in-rheumatoid-arthritis/. Accessed .

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