Background/Purpose: ultrasound (US) is able to show subclinical synovitis in patients (pts) with rheumatoid arthritis (RA) who are in clinical remission (CR); this has been proposed as a predictive factor for both clinical flares and progression of the structural damage in CR pts. The aim of this work was to investigate the US characteristics of RA pts presenting either CR or low disease activity (LDA).

Methods: in 2015 and 2016 an educational event focus on the added value of US in RA pts was held in 22 rheumatology centers in Italy. After a brief presentation on the evidence of the added value of US for the clinician given by expert sonographers (rheumatologists with a special interest in US who were performing US as their usual activity since many years), in every center, the local rheumatologists provided RA pts to be examined by US. All of the US machine were identical both for type (Logiq E R7, General Electrics, with a 4.2-13 MHz linear probe) and settings (both for grey-scale and power Doppler (PD)). Pts signed an informed consent and a brief history of them was collected by the local rheumatologists (previous and current therapy, DAS28, HAQ score). The US examination was performed bilaterally on wrists, MCP and MTP joints, looking for synovitis (effusion, synovial proliferation and PD) and erosions. The positive findings were scored according to a 0-3 score for synovitis components and presence/absence for erosions; the number and dimensions of the largest erosion were also registered.

Results: demographic and descriptive data of the 1466 pts examined are reported in Table I. Pts were divided on the basis of the DAS28 result. A statistically significant difference in age was registered between the group in CR and the group with DAS28>3.2 (p=0.003), while no differences were found for HAQ or MTX use. Higher prevalence of findings (regardless the score) was present in LDA group with respect to the CR one for effusion, synovial proliferation, PD and erosions, with significant differences for effusion (global, wrist, MCP and MTP joints; p=0.001, 0.024, 0.001 and 0.000 respectively), synovial proliferation effusion (global, wrist and MTP joints; p=0.019, 0.005, and 0.029 respectively), PD positivity (global, wrist, MCP and MTP joints; p=0.000, 0.000, 0.001, and 0.000 respectively) and erosions (global and MCP joints; p=0.009 and 0.000 respectively).

Table I: demographic data

Conclusion: in this large group of RA pts, US showed frequent abnormalities both in the CR and in the LDA group. Our results are in line with previous studies and confirm that US is a useful imaging tool for the detection of subclinical joint abnormalities in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-recall-program-data-from-a-multicenter-educational-event-on-patients-with-rheumatoid-arthritis/