Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: At the present time remission is the target for treatment of rheumatoid arthritis (RA). Various composite indices are available that can be used to define remission. Although the new ACR/EULAR Boolean criteria is more stringent than others, it is difficult to achieve and even more difficult to sustain this Boolean remission. In this study we aimed to determine the difference of the ultrasonographically (US) assessed actual disease activity of the patients with Boolean remission compared to patients in remission according to other remission criteria.
Methods: RA patients in clinical remission (DAS28-ESR<2.6) for at least 3 months were included to this cross-sectional study. All patients’ remission status according to DAS28-ESR-3, DAS28-CRP, SDAI, CDAI and Boolean based definitions were assessed. A standard gray scale (GS) and power Doppler (PD) US examination of 28 joints (included in DAS28) for the presence of synovitis was performed by an experienced sonographer (NI) blinded to clinical data. US synovitis GS and PD signals were semiquantitatively graded from 0 to 3. Total PD and GS synovitis scores of all sites are recorded as sum scores of PD and GS, respectively.
Results: A total of 55 out of 302 RA patients (18.2%) in DAS28 remission were enrolled (F/M=35/20, mean age 52.2±12.0, disease duration 11.0±6.5 years, biologic treatment 43.6%, RF or Anti-CCP positivity 76.4%). Of those 55 patients, 41 (74.5%), 36 (65.5%), 31 (56.4%) and 25 (45.5%) fulfilled the DAS28-ESR-3, SDAI, CDAI and Boolean remission criteria, respectively. SDAI and Boolean remission had the highest percentage of patients with PD signals ≤1, which has shown to be associated with erosion development and worse functional outcome. However despite that, those differences in US disease activity parameters (both PD and GS synovitis sum scores and percentages of patients without PD and GS signals [with both omitting and including grade 1 signals]) in remission patients according to different criteria were not statistically significant. US disease activity parameters of clinical remission group according to different criteria were similar as well, compared to their counterpart nonremission group.
Conclusion: US verified joint inflammation is the lowest in RA patients who are in remission according to Boolean and SDAI criteria. The clinical significance of this statistically nonsignificant inflammatory activity compared to other clinical remission criteria should be assessed in prospective studies. Till then, in clinical practice if Boolean remission could not be achieved, SDAI and also other clinical remission criteria could also be preferred as the remission target.
Table 1.Differences in US disease activity findings and acute phase reactants depending on remission status defined by different criteria
|
|
DAS28-ESR REM (n=55) |
DAS28-CRP REM (n=53) |
DAS28-ESR-3 REM (n=41) |
SDAI REM (n=36) |
CDAI REM (n=31) |
Boolean REM (n=25) |
|
PD sum score (0-84) |
2 (0-5) |
2 (0-5) |
1 (0-4.5) |
1 (0-4.7) |
1 (0-4) |
1 (0-4.5) |
|
GS sum score (0-84) |
4 (1-8) |
3 (1-8) |
3 (1-7.5) |
4 (1-8) |
4 (0-8) |
3 (0-6.5) |
|
PDGS sum score (0-168) |
5 (1-13) |
5 (1-14) |
5 (1-11.5) |
4.5 (1.2-12.5) |
4 (1-11) |
4 (0.5-11) |
|
US joint count with PD signal (0-28) |
1 (0-3) |
1 (0-3) |
1 (0-3) |
1 (0-3) |
1 (0-3) |
1 (0-3) |
|
US joint count with GS signal (0-28) |
3 (1-4) |
3 (1-4) |
2 (1-4) |
2.5 (1-4) |
2 (0-4) |
2 (0-4.5) |
|
PD =0 ƪ |
17 (30.9) |
17 (32.1) |
13 (31.7) |
10 (27.8) |
10 (32.3) |
9 (36) |
|
PD≤1 ƪ |
31 (56.4) |
31 (58.5) |
26 (63.4) |
22 (71) |
19 (61.3) |
16 (64) |
|
GS=0 ƪ |
10 (18.2) |
10 (18.9) |
9 (22) |
7 (19.4) |
8 (25.8) |
7 (28) |
|
GS≤1 ƪ |
25 (45.5) |
25 (47.2) |
21 (51) |
16 (44.4) |
15 (48.4) |
12 (48) |
|
PD=0 and GS=0 ƪ |
9 (16.4) |
9 (17) |
8 (19.5) |
6 (16.7) |
7 (22.6) |
6 (24) |
|
PD≤1 and GS≤1 ƪ |
23 (41.8) |
23 (43.3) |
19 (46.3) |
15 (41.7) |
15 (48.4) |
12 (48) |
|
USJC with PD=0 ƪ |
17 (30.9) |
17 (32.1) |
13 (31.7) |
10 (27.8) |
10 (32.3) |
9 (36) |
|
USJC with PD≤1 ƪ |
31 (56.4) |
31 (58.5) |
26 (63.4) |
22 (61.1) |
19 (61.3) |
16 (64) |
|
USJC with GS=0 ƪ |
10 (18.2) |
10 (18.9) |
9 (22) |
7 (19.4) |
8 (25.8) |
7 (28) |
|
USJC with GS≤1 ƪ |
25 (45.5) |
25 (47.2) |
21 (51.2) |
16 (44.4) |
15 (48.4) |
12 (48) |
|
*The values were presented as median (25-75p) unless indicated otherwise. ƪ The values were presented as n (%)
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To cite this abstract in AMA style:
Ozen G, Unal AU, Topcu A, Atagunduz P, Direskeneli H, Inanc N. Ultrasonographic Disease Activity in Rheumatoid Arthritis Patients Who Are in Clinical Remission According to Different Remission Criteria: Should We Insist on Achieving Boolean Remission? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/ultrasonographic-disease-activity-in-rheumatoid-arthritis-patients-who-are-in-clinical-remission-according-to-different-remission-criteria-should-we-insist-on-achieving-boolean-remission/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonographic-disease-activity-in-rheumatoid-arthritis-patients-who-are-in-clinical-remission-according-to-different-remission-criteria-should-we-insist-on-achieving-boolean-remission/