Session Information
Date: Monday, November 6, 2017
Title: Imaging of Rheumatic Diseases I: Novel Imaging and Scoring Systems
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose :Tenosynovitis is very common in patients with RA and is associated with lower physical function. Several studies have confirmed the limitations of clinical examination for detection of tenosynovitis in comparison with ultrasound (US) and a highly validated and reliable US scoring system is therefore needed if implementing US-tenosynovitis as an outcome measure in clinical trials. The OMERACT US group’s tenosynovitis scoring system has a good single and multicenter intra- and inter-observer agreement, whereas the sensitivity to change in a multicenter design has never been tested.
Furthermore, it is unknown whether low grade synovial hypertrophy without Doppler Signal represents true inflammation, i.e. can be eliminated by anti-inflammatory therapy and is sensitive to change.
The aim of this study was to test the sensitivity to change of the OMERACT US scoring system for tenosynovitis, including minimal signs of tenosynovitis, in a multicenter design in order to validate it as an outcome measure in RA multicenter clinical trials. Furthermore, to assess the association between US and HAQ and DAS28.
Methods: Forty-nine patients with established RA (duration ≥1 year) and 18 early RA patients (<1 year) with US-verified tenosynovitis were recruited from six rheumatology outpatient clinics in four different countries, if they were scheduled for treatment intensification with synthetic and/or biological DMARD. Tenosynovitis was assessed at baseline, and at three and six months’ follow-up, by GS and Doppler, using the semi-quantitative OMERACT scoring system. Furthermore, HAQ and DAS28 were assessed.
Results: At baseline tenosynovitis was most frequently found at the extensor carpi ulnaris and tibialis posterior tendons (70.7% and 44.4%, respectively). The overall GS score showed a statistically significant decrease from baseline median 5 (25th;75th percentile: 2;7) to 6 months 0 (0;3) and the overall Doppler score decreased statistically significant from baseline 3 (2;6) to 6 months 0 (0;1), both with a p<0.01. Both GS and Doppler showed high responsiveness (SRM>0.9), as did HAQ and DAS28 (table 1). Among tendons with grey scale (GS)=1/Doppler=0, 36 of 39 (92.3%) showed therapy-induced improvements. Changes in US-scores were statistically significantly associated with DAS28 (p=0.02), but not with HAQ.
Conclusion: In conclusion, this RA multicenter study documented a high sensitivity to change of both GS and Doppler US tenosynovitis scores, indicating utility of the OMERACT US scoring system for diagnosing and monitoring tenosynovitis in multicenter trials. Secondly, synovial hypertrophy without Doppler signal, do respond to therapy, suggesting it reflects true inflammation. Finally, changes in US tenosynovitis scores are associated with changes in DAS28.
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All Sites – Imaging modality
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Baseline
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Δ 0-3 month
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P
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SRM
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Δ 3-6 month
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P
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SRM
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Δ 0-6 month
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P
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SRM
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||||||
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(n=67)
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Grey scale
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Median [25p;75p]
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4
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[2;7]
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-2
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[-3;-0]
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<0.01
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0.8
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-1.0
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[-2;0]
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<0.01
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0.4
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-2
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[-5;-5]
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<0.01
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0.9
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Mean ±SD
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5.0
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±3.4
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-2.4
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±2.9
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-0.9
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±2.4
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-3.3
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±3.8
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Doppler
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Median [25p;75p]
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3
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[2;6]
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-2
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[-4;-1]
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<0.01
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0.8
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0
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[-2;0]
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<0.01
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0.3
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-3
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[-5;2]
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<0.01
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0.9
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|||
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Mean ± SD
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1.2
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±0.66
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-0.8
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±0.6
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0
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±0.2
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-0.7
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±0.6
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DAS28
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Median [25p;75p]
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4.6
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[3.7;5.3]
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-1.4
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[-48;-2]
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<0.01
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0.9
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-0.4
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[-1.3;0.1]
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<0.01
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0.3
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-1.6
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[-3.2;-0.7]
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<.0.01
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1.1
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Mean ±SD
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4.4
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±1.3
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-1.4
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±1.5
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-0.5
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±1.5
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-1.8
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±1.7
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HAQ
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Median [25p;75p]
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1.0
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[0.5;1.5]
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-0.25
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[-0.75;0]
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<0.01
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0.8
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0
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[-0.25;0]
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0.02
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0.3
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-0.375
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[-0.875;0]
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<.0.01
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0.9
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Mean ± SD
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1.0
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±0.6
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-0.4
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±0.4
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-0.1
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± 0.3
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-0.5
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± 0.5
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P, p-value for Wilcoxon’s test for change of paired data between 2 time points; N, number of patients; SRM, standardized response mean.
To cite this abstract in AMA style:
Ammitzbøll-Danielsen M, Østergaard M, Naredo E, Iagnocco A, Moller I, D'Agostino MA, Gandjbakhch F, Terslev L. The Utility of the Omeract Ultrasound Tenosynovitis Scoring System in Multicenter Clinical Trials [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-utility-of-the-omeract-ultrasound-tenosynovitis-scoring-system-in-multicenter-clinical-trials/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-utility-of-the-omeract-ultrasound-tenosynovitis-scoring-system-in-multicenter-clinical-trials/